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A  MANUAL  OF 

Medical  Jurisprudence, 

WITH  SPECIAL  REFERENCE  TO 
DISEASES  AND  INJURIES  OF  THE 

NERVOUS   SYSTEM. 


BY 

ALLAN  McLANE  HAMILTON,  M.  D., 

One  of   the  Consulting  Physicians  to  the   Insane  Asylums  of   New  Yori 
City,   etc.,   etc. 

WITH  ILL  USTRA  TIONS, 


NEW  YORK : 

E,  B.  TREAT.  5  Cooper  Union. 

CHICAGO:    199  Clark  St.  LONDON:     136  Grower  St. 

iSoo.  Price,  $2.75. 


i 


COPYRIGHT,  1887. 

By 
E.  ]].  TREAT,  N.  Y 


> 


ai 

CO 

^ 

Ji 

■? 

^' 


s 


TO   MY   FATHER, 

PHILIP  HAMILTON,  Esq. 

WHOSE  HONORABLE   CAREER 

AND   UNBLEMISHED   LIFE, 

BRING  TO   HIM   THE 

REWARD   OF 

HAPPY  OLD  AGE. 


IN 


6FTHE 


PREFACE. 


This  little  book  is  presented  as  an  elementary  tieatise, 
and  book  of  reference,  for  lawyers  and  doctors. 

Its  scope  is  limited,  for  I  have  considered  only  those 
conditions  of  the  nervous  system  which  nowadays  are  so 
otteii  the  bases  of  litigation  ;  and  as  a  guide  in  such  cases 
I  trust  it  will  prove  useful. 

20  East  29TH  St.,  N.  Y. 


CONTENTS. 


CHAPTER   I. 


Insanity. 


CHAPTER    II. 

Insanity  in  its  Medico-Legal  Relations. 


17 


61 


CHAPTER   HI. 

.Hysteroid  Conditions  and  Feigned  Diseases. 


170 


Epilepsy, 


CHAPTER   IV. 


221 


Alcoholism. 


Suicide. 


Cranial  Injuries. 


Spinal  Injuries. 


CHAPTER  V. 


CHAPTER  VI. 


CHAPTER   VII. 


CHAPTER  VIII. 


24S 


275 


301 


342 


INSANITY. 


CHAPTER  I. 


GENERAL    CONSIDERATION. 


Defluitiou. — No  definition  of  Insanity  exists  that  will  stand 
legal  analysis,  and  it  is  exceedingly  unwise  in  courts  of  law 
to  attempt  to  give  one.  It  is  a  favorite  method  with  lawyers 
to  make  the  medical  witness  commit  himself  in  defining  the 
word,  and  then  hopelessly  entangle  him  in  quibbles. 

For  practical  purposes  Insanity  may  be  said  to  be  an  im- 
pairment of  the  mind,  manifested  by  intellectual,  moral  and 
emotional  perversion,  and  due  to  physical  changes  of  the  brain, 
other  than  those  temporarily  produced  by  intoxicants,  or  the 
poison  of  fevers. 

The  two  definitions  that  are  the  most  satisfactory  are  those 
of  Bucknill  and  Maudsley. 

The  former  defines  insanity  as  *'  a  disease  of  the  brain  (idio- 
pathic or  sympathetic)  affecting  the  integrity  of  the  mind, 
whether  marked  by  intellectual  or  emotional  disorder." 

Maudsley's  definition  is  as  follows: 

"  Insanity  is,  in  fact,  disorder  of  brain,  producing  disorder 
of  mind;  or,  to  define  its  nature  in  greater  detail,  it  is  a  disord- 
er of  the  supreme  nerve  centers  of  the  brain, — the  special 
organs  of  mind, — producing  derangement  of  thought,  feeling, 
and  action,  together  or  separately,  of  such  degree  or  kind  as  to 
incapacitate  the  individual  for  the  relations  of  life.  Mind  may 
be  defined  physiologically  as  a  general  term,  denoting  the  sum 
total  of  those  functions  of  the  brain  which  are  known  as 
thought,  feeling,  and  will.  By  disorder  of  the  mind  is  meant 
disorder  of  these  functions." 

It  will  be  seen  that  Bucknill  insists  upon  actual  disease  oi 
the  brain  while  Maudsley  rather  leans  to  the  view  that  the 
mind  as  a  function  is  disordered,  and  he  makes  the  distinction, 
however,  calling  attention  to  the  fact  that  numerous  diseases 
of  the  brain  are  not  attended  by  insanity,  but  are  attended  by 


l8  MEDICAL  JURISPRUDENCE. 

mental  changes.  I  prefer  the  definition  of  Bucknill  which 
comes  more  directly  to  the  point,  and  until  experimental  psy- 
chological-physiology and  pathology  enable  us  to  localize  the 
supreme  mental  centers,  we  cannot  he  more  exact. 

Legal  Deflllition.— Bucknill  advises  the  medical  witness 
who  is  asked  to  define  insanity,  that  he  should,  in  addition  to 
the  medical  definition  given  above,  add  the  words,  "  that  the 
cerebro-mental  disorder  is  such  as  to  suspend  or  impair  the 
action  of  the  healthy  will," 

General  Indications  of  Insanity. — The  expressions  of 
insanity  are  of  the  most  varied  character,  and  in  the  examina- 
tion of  any  particular  case,  it  should  be  our  aim  to  determine 
the  existence  and  meaning  ^f  any  change  in  temper  or  habits, 
and  any  unlooked  for  act  whether  the  result  of  premeditation 
or  morbid  impulse.  There  are  also  physical  alterations,  as 
well  as  mental.  Of  course  the  evidences  of  such  a  departure 
from  the  normal  state  as  we  are  often  called  upon  to  explain, 
vary  with  the  forms  of  insanity,  of  which  there  are  many. 

The  indications  of  a  disordered  mind  are  manifested  in  dis- 
turbance of  the  emotions,  the  reasoning  powers,  the  judgment, 
the  memory,  and  the  will  of  the  individual,  and  though  various 
types  of  insanity  resemble  each  other,  no  two  cases  can  be  said 
to  be  exactly  alike.  We  should  be  on  the  alert  to  discover  the 
presence  of  delusions,  hallucinations  and  illusions,  the  evidences 
of  impaired  will  power,  the  feebleness  of  the  memory,  and  the 
alteration  of  the  moral  nature  of  the  patient. 

Classifications  of  Insanity. — The  following  great  divisions 
of  insanity  may  be  made: 
Idiocy. 
Imbecility. 
Mania,  ) 

>•  Acute  and  Chronic 
Melancholia,    ) 

Dementia. — Primary  and  Secondary. 
General  Paresis  of  the  the  Insane. 


Dickson's  classification. 
One  of  the  best  classifications  of  Insanity  is  that  of  Dickson.* 
*  Medicine  in  Relation  to  Mind,  u  aix 


GENERAL    CONSIDERATION. 


to 


Insanity.  •< 


Q 

t/3 

OS 
03 


Variety  I.  Involving  emotions;  f 
delusion  not  necessarily  obvious  J 
but  reasoning  power  impaired  j 
or  overwhelmed.  [^ 

Variety  II.  Involving  intellect; 
<5  delusion    essential,    reasoning 
power  not  necessarily  impaired  ' 
but  judgment  warped. 

Variety  III.  Involving  all  the  ( 
mental  faculties  ;  delusion  not  < 
essential.  ( 


A.  Excitation. 

B.  Depression. 


A.  Excitation. 

{Mania). 

B.  Depression 
{Melancholia) 


Passive  state. 
{Deinentid) 


Sub-class 
Amentia 


Congenital  deficiency  of  j  Idiocy, 


mental  faculties. 


Imbecility. 


There  are  various  classifications  which  might  be  reproduced 
in  these  pages  if  space  would  permit.  Some  of  them  deal  with 
the  etiological  factors.  Those  of  Pritchard,  Griesinger  and 
Maudsley  divide  mental  disease  into  two  classes,  the  Intellect- 
ual and  Emotional.  The  Germans,  notably  Krafft  Ebing, 
are  fond  of  generalization,  and  we  consequently  find  very 
elaborate  terminology.  A  favorite  scheme  in  this  country  is 
that  of  Ray  which  is  the  following: 

ray's  classification. 


'Deficient  devel-  fj  ,•        j  from  congenital  defect, 
opment   of    the  J    j^uj  |  from  arrested  development  in  infancy, 
mental  faculties  |  „;i;...  "  (  from  congenital  defect. 

from  arrested  development  in  infancy. 


Insani 


<,.{ 


cility. 


Lesion  of 
mental 
faculties, 
sub  s  e 
quent  to 
their  de- 
vel op  - 
ment. 


Mania 


(Mania of   authors,  ex- 
citation of  the  faculties 
Melancholia   or  lype- 
I  mania  of  authors,  de- 
Palrtial    (_pression  of  faculties. 


'  Intellect- 
ual ;main- 
ly  affect- 
ing     the 
(of  Ray)  \  intellect. 

Moral;  (  General  (  Monomania  of  authors 
mainly-<  \  Partial  affection  of  the 

affecting  (  Partial.    (  faculties. 
[  the  will. 

Consecutive  to  mania  or  injuries  of  brain. 
Senile,  peculiar  to  old  age. 
(See  Appendix  A.) 


Dementia. 


2Q  MEDICAL  JURISPRUDENCE. 


Monomania,  Moral  and  Partial  Insanity. 

There  is  scarcely  a  classification  that  does  not  include  sub- 
divisions of  the  above,  and  many  of  them  embrace,  like  that  of 
Ray,  Monojnania,  Mora/  and  Partial  Insanity.  When  it  is  re- 
membered that  in  nearly  all  carefully  studied  cases  of  either 
Melancholia  or  Mania,  though  there  is  a  prevailing  delusion, 
there  is  as  well  a  variety  of  others.  The  term  Alonomania 
is  an  impractical  refinement.  So  too.  Moral  Insanity  I  am 
convinced  should  have  no  isolated  place,  for  I  do  not  be- 
lieve that  such  a  condition  can  exist  without  general  intellectual 
perversion,  which  latter,  however,  may  be  masked  or  obscured.  It 
is  impossible  to  have  insanity  limited  to  one  faculty  of  the  mind 
so  I  think  the  X.Q.\vi\  partial  is  a  misnomer  as  well  when  applied 
to  a  diseased  mental  state,  and  much  confusion  arises  from  con- 
founding "partial  responsibility,"  which  may  exist,  with  partial 
insanity  which  I  believe  we  have  no  more  right  to  consider  than 
"  partial  "  malaria  or  "  partial  "syphilis.  These  terms  are  only 
relative  at  best,  and  are  convenient  but  dangerous.  It  is  uni- 
versally conceded  that  there  may  be  forms  of  general  insanity 
in  which  certain  delusions  predominate,  or  in  which  there  may 
be  a  conspicuous  defect  in  the  morals  of  the  individual,  but 
this  is  all.  Various  convenient  terms  have  been  used  to  ex- 
press the  dominant  character  of  the  patient's  insane  tendencies, 
and  these  are  valuable  in  a  nosological  sense.  We  find  allu- 
sion to  homicidal  mania^  suicidal  mania,  erotomania,  dipsomania^ 
kleptomania,  pyrotnania,  etc.  So  too,  other  varieties  of  insanity 
derive  their  names  from  their  causation  or  circumstances  undtr 
which  they  appear. 

Somatic  ClaSSiiication. — Post  Comiubial,  Puerperal,  Cli- 
macteric Insanity  are  applied  to  various  conditions  of  sexual 
development,  excitement,  or  decay,  as  are  Nymphomania,  and 
Satyriasis,  and  Masturbatic  insanity.  Toxic,  Diabetic,  Metas- 
tatic, Syphilitic,  Epileptic,  Phthisical,  and  Traumatic  insanities 
are  varieties  dependent  upon  poisoning,  disease  or  injury, 
while  we  speak  of  "Senile"  dementia  to  qualify  the  condition, 
by  suggesting  the  question  of  age  in  regard  to  that  particular 
disease,  or  Pubescent  insanity  to  indicate  the  fact  that  the 
mental  disease  is  connected  with  the  general  development  of 
change  that  occurs  at  adolescence. 

The  terms  used  by  Skae  *  include  many  of  the  above  as  well  as 

*  Journal  of  Menial  Science,  Oct.,  1873. 


GENERAL    CONSIDERATION.  21 

others  having  a  pathological  significance.  He  further  divides 
idiopathic  insanity  into  sthenic  and  asthenic  with  regard  to  the 
dynamic  expression  of  the  mental  derangement.  The  true 
division  of  the  subject,  however,  should  be  a  simple  one,  and 
it  is  injudicious  to  specialize  etiological  conditions,  which  may, 
after  all,  have  the  same  method  of  expression. 

The  first  three  varieties  of  insanity  to  be  considered  are  those 
characterized  by  mental  feebleness  and  include  idiocy,  imbecility, 
and  dernentia.  The  first  is  considered  by  some  authors  to  be 
congenital  and  acquired ;  I  think,  however,  the  so-called  acquired 
idiocy  should  be  defined  as  imbecility. 

Idiocy,  then,  is  a  congenital  condition  manifested  by  imper- 
fect development  of  both  mind  and  body.  The  idiot  is  either 
non  compos,  or  his  capacity  is,  as  Pinel  has  observed,  below  that 
of  another  person  of  his  own  age.  In  some  cases  the  intelli- 
gence is  even  upon  a  par  with  that  of  some  of  the  lower 
animals,  and  his  mental  expression  is  chiefly  emotional.  He 
manifests  feeble  degrees  of  pleasure  when  he  is  shown  bright 
objects,  and  indulges  in  fitful  and  short-lived  gusts  of  passion 
without  cause.  He  delights  in  rhythmical  musical  sounds,  and 
is  fond  of  repeating  one  word  over  and  over,  or  indulges  in 
automatic  movements. 

The  instinct  of  the  idiot  is  animal,  and  his  habits  are  of  the 
most  repulsive  kind  ;  without  the  restraint  of  judgment  he 
gratifies  every  appetite,  however  low.  In  completely  idiotic 
persons  there  is  no  sign  of  recognition,  no  indication  of  mem- 
ory, and  the  intellectual  capacity  is  not  to  be  compared  to  that 
of  some  intelligent  animals.  There  is  the  absence  of  the  mental 
apparatus,  the  absence  probably  of  a  sufficient  number  of  sen- 
sory cells  and  their  connecting  filaments,  and  the  result  is  the 
absence  of  mind. 

Balfour  Browne  says  :  "  Thus  we  see  that  an  idiot  is  a  person 
so  thoroughly  without  mind  that  all  mental  cultivajtion  has  been, 
and  is,  out  of  the  question.  It  is  as  difficult  to  make  money 
without  some  capital,  either  in  money  or  the  power  to  labor,  as 
to  acquire  knowledge  without  a  brain.  To  distinguish  idiocy 
clearly  from  dementia  with  which  it  is  sometimes  confounded, 
it  must  be  remembered  that  the  former  is  a  congenital  absence 
or  at  least  serious  defect  of  all  the  faculties  of  mind,  while  de- 
mentia may  be  regarded  as  the  gradual  obliteration  of  faculties 
which  have  been  possessed." 

There  are  idiots,  however,  in  whom  the  imperfection  of  the 
cerebral  structures  is  not  so  extreme,  and  in  whom  the  above- 


22  MEDICAL   JURISPRUDENCE. 

mentioned  condition  of  mind  does  not  exist  to  so  great  a  de- 
gree. We  find  in  every  asylum  many  idiots  who  in  some  ways 
manifest  a  partial  brightness,  if  it  may  be  so  called,  of  a  few 
faculties.  They  are  docile  and  tractable.  It  is  possible  to  do 
a  great  deal  for  them,  and  they  may  be  taught  much  more 
readily  than  the  imbeciles  whose  weakness  results  from 
disease.  The  idiotic  child  may  be  sometimes  taught  to  talk,  to 
read,  and  with  great  care  and  training  by  means  of  object  teach- 
ing and  judicious  discipline,  he  may  be  raised  to  a  level  much 
above  that  he  once  occupied. 

Head  Configuration  of  Idiots. — Idiots  often  present 
peculiar  physical  defects  which  are  sometimes  remarkable,  and 
this  is  especially  the  case  in  hereditary  cases.  The  configur- 
ation of  the  head  is  one  of  these,  and  Broca  has  described 
several  varieties,  the  most  important  of  which  is  the  microce- 
phalous head.  The  diminutive  head  may  have  a  circumference 
of  but  thirteen  inches,  and  an  exceedingly  great  facial  angle. 
Broca  holds  that  the  possessor  of  a  skull  with  an  antero-pos- 
terior  diameter  of  148  millimeters  is  a  microcephale. 

Of  the  two  principal  varieties  the  dwarfed  idiot,  and  the  idiot 
of  ordinary  height  {les  naitis,  et  les  invidus  de  faille  ordinaire)  the 
latter  are  almost  always  deprived  of  the  faculty  of  language — ' 
sometimes  they  can  pronounce  a  few  words  without  any  appre- 
ciation of  what  they  mean.  The  cranium  is  larger  than  that  of 
the  first  variety,  and  may  be  140-145  millimeters  in  length,  and 
may  have  a  circumference  of  420-425  millimeters,  and  a  capa- 
city of  from  600-700  cubic  centimeters. 

The  greater  number  of  microcephalous  idiots  are  of  the  first 
variety  (dwarfs)  and  rarely  grow  taller  than  a  boy  of  eight 
years  (Broca).  Many  always  remain  undeveloped ;  others 
are  taught  to  talk,  and  but  few  advance  beyond  the  mental 
status  of  a  child  of  two  years.  The  antero-posterior  diameter 
of  the  skull  may  be  no  more  than  over  10  to  13  centimeters,  the 
ho*'izontal  circumference  may  be  from  32-37  centimeters,  and  the 
capacity  is  always  below  600,  and  may  be  no  more  than  300 
cubic  centimeters.  Other  idiotic  heads  are  referred  to  by 
Broca — the  demi-microcephale.  The  scaphocephalous  defor- 
mity consists  of  an  exaggeration  of  the  vertical  and  longitudinal 
diameters  ;  iht  plagiocephalous  or  oblique-oval  deformity,  which 
depends  upon  premature  obliteration  of  one  of  the  branches  of 
the  coronal  suture,  and  of  the  laml^doidal  suture.  In  ihc pla/yce. 
phaloiis  deformity  the  sinciput  is  flattened  and  the  vertical 
diameter  is    diminished.     In  the   acrocephalous    head,  on  the 


GENERAL   CONSIDERATION.  23 

contrary  the  sinciput  is  conical,  and  there  is  an  increase  in  the 
vertical  diameter  (Broca).  Various  other  uncommon  deformi- 
ties are  the  result  of  premature  closure  of  other  sutures. 

The  association  of  atypical  cranial  with  various  bodily  de- 
formities should  suggest  idiocy  rather  than  imbecility.  This 
is  true  especially  in  regard  to  the  condition  of  the  mouth.  The 
teeth  of  the  idiot  are  apt  to  be  irregular,  double,  or  connected 
with  some  imperfection  of  the  hard  palate,  such  as  vaulting  or 
fissure  ;  or  the  alveolar  process  may  be  projecting. 

The  features  of  the  idiot  are  coarse  and  his  mouth  is  large. 
His  vision  is  defective  and  he  is  apt  to  suffer  from  disease  not 
only  of  the  eyeball  itself,  but  its  muscles  as  well,  so  that  there 
may  be  atrophy  of  the  disk,  cataract,  or  strabismus,  and  there  is 
an  inability  to  fix  the  eye  upon  small  objects.  The  hair  upon  the 
body  of  the  idiot  is  sometimes  coarse  and  plentiful,  or  on  the 
other  hand  is  unusually  fine  and  silky,  though  this  latter  condi- 
tion of  affairs  is,  I  think,  more  marked  in  imbecility.  Idiots  are 
slow  and  awkward  in  their  movements,  disinclined  to  work,  and 
the  muscular  system  is  weak.  Cutaneous  sensibility  may  be 
either  elevated  or  depressed  ;  in  the  latter  case  there  is  toler- 
ance of  external  disagreeable  irritation — flies  crawling  on  the 
skin  or  the  bite  of  insects  produce  little  discomfort.  The  gait 
of  the  idiot  is  often  waddling  and  unsteady,  and  his  grasp 
weak.  His  habits  are  untidy  and  sometimes  disgusting.  He 
gorges  himself  with  whatever  may  be  placed  before  him,  and 
often  carries  in  his  mouth  a  bolus  of  food  for  hours  at  a  time. 
He  voids  his  urine  and  feces  wherever  he  may  be,  and  very 
often  indulges  in  masturbation  and  objectionable  amusements 
of  a  vile  character. 

Idiocy  is  due  much  more  often  to  the  intemperance  of  the 
progenitors  than  to  any  other  cause.  Of  359  idiots  seen  by 
Dr.  Howe,  it  was  found  that  in  99  cases  the  parents  were  con- 
firmed drunkards.  Consanguineous  marriages  are  believed  by 
Maudsley  to  lead  more  often  than  is  generally  supposed  to 
degeneracy  which  is  manifested  in  succeeding  generations  by 
idiocy.  How  much  syphilis  predisposes  to  this  condition  it  is 
difficult  to  say.  The  longevity  of  idiots  is  short  and  they  rarely 
live  beyond  the  age  of  thirty. 

Cretinism. — A  rare  form  of  idiocy  is  known  as  Cretinism, 
which  was  formerly  supposed  to  be  purely  of  limited  endemic 
origin,  but  such  is  not  the  case.  The  skin  is  infiltrated  with 
a  mucoid  substance  giving  the  person  a  distorted,  bloated 
appearance.     The  thyroid  gland  is  either  enlarged  or  entirely 


24  MEDICAL   JURISPRUDENCE. 

absent,  the  mouth  is  large,  and  the  hands  and  fingers  mis- 
shapen and  "  clubbed."  The  eyes  are  squinting,  the  com- 
plexion pale  and  sallow,  and  the  speech  is  thick  or  muffled. 
There  is  usually  sluggishness  of  movement  and  lowered  surface 
temperature.     The  mental  condition  is  allied  to  that  of  idiocy. 

Iml)ecilit.y  is  distinguished  from  idiocy  in  the  fact  that  it  is 
due  to  disease  of  the  brain  commencing  usually  shortly  after 
birth,  that  unlike  idiocy,  the  bodily  defects  are  asymmetrical 
and  the  intellectual  imperfections  are  rather  different,  the  mind 
of  the  imbecile  being  insusceptible  to  training  except  to  a 
limited  degree. 

The  power  of  speech  is  not  absent,  so  often  as  it  is  in  the 
idiot,  and  when  speech  disturbances  exist  they  are  usually 
aphasic  or  ataxic. 

The  mental  characteristics  of  the  imbecile  are  manifested  in 
low  mischievous  cunning,  bad  temper,  silliness  and  stupidity. 
The  condition  is  accompanied  by  epilepsy  or  paralysis.  I  do 
not  agree  with  Browne,  who  says  that  it  is  impossible  to  make 
a  distinction  between  idiocy  and  imbecility.  There  is  in  most 
imbeciles  some  indication  of  the  existence  of  mind,  though  its 
manifestations  are  weak  and  distorted  and  almost  blotted  out. 

Weak-Milldedliess. — The  degrees  of  imbecility  vary  greatly, 
and  at  one  end  of  the  line  we  find  the  person  of  weak  mind, 
while  successively  we  find  the  vicious  imbecile,  "  the  fool,"  the 
eccentric  individual  whose  eccentricity  is  diseased  ;  and  various 
other  representations,  until  we  reach  the  other  end  to  find  the 
subject  whose  mental  state  is  so  low  that  he  resembles  the  idiot 
in  the  paucity  of  his  intellect. 

Congenital  Ticiousness. — Ogston  speaks  of  another  class 
of  persons  who  are  undoubtedly  imbecile. 

"  Short  of  this,"  he  says,  "  we  have  a  class  of  beings  in  whom 
the  mental  deficiency  is  less  apparent  and  less  easily  proved  to 
exist,  and  who  are  considered  by  medical  authorities  to  be  irre- 
sponsible, though  they  frequently  become  objects  of  punish- 
ment before  the  criminal  tribunals.  They  are  mostly  found 
amongst  the  lower  classes  of  society,  are  capable  of  some  easy 
occupations,  are  looked  upon  as  simpletons,  and  often  as  such 
subjected  to  much  annoyance.  They  are  often  lazy  and 
drunken,  are  dextrous  in  thievmg  and  are  thought  to  be  very 
cunning.  They  are  sometimes  violent  and  passionate,  commit- 
ting homicide  or  arson  upon  the  least  provocation.  These, 
too,  have  strong  sexual  propensities,  are  easily  betrayed  into 


GENERAL    CONSIDERATION. 


25 


outrages  on  modesty.  In  such  cases,  though  the  medical  man 
may  not  discern  that  the  individual  is  insane,  he  may  perceive 
that  he  is  not  quite  right  in  his  mind,  for  in  most  of  these  cases 
there  is  something  about  the  individual  which  makes  him  un- 
like the  generality  of  other  people.  There  seems  in  all  such 
persons  some  want  of  intellect.  'I'hey  do  not  appear  to  possess 
the  same  composure  of  mind  as  common  people.  They  have  a 
great  look  of  cunning,  or  of  vacancy  or  unsettledness.  They 
will  speak  rationally  and  with  consideration,  but  not  with  or- 
dinary energy  or  depth  of  reflection,  and  consequently  their 
judgment  appears  to  be  impaired.''  Many  people  of  this  class 
have  been  sentenced  to  punishment,  sometimes  unjustly,  per- 
haps, but  great  care  is  necessary  in  pronouncing  upon  the  re- 
sponsibility of  one  of  this  kind.  The  nature  of  the  crime 
itself,  and  its  motiveless  or  wanton  character  should  be 
considered  in  connection  with  the  mental  condition  of  the  per- 
son, and  every  care  should  be  taken,  for  society  needs  protec- 
tion as  well  as  the  criminal. 

Many  so-called  cases  of  moral  insanity  are  built  upon  the 
foundation  of  congenital  viciousness. 

Dementia. — Dementia  is  a  term  used  to  define  the  con- 
dition manifested  by  a  decay  of  the  mental  powers.  It  is 
always  attended  by,  an  enfeeblement  of  intellect,  and  in 
the  latter  stages  there  is  a  blotting  out  of  every  thing  like 
intelligence.  We  may  consider  it  as  a  state  commencing 
in  early  life  as  the  result  of  shock  or  disease  ;  a  conse- 
quence of  acute  insanity — a  result  of  coarse  cerebral  disease 
or  injury  (commonly  vascular  plugging  such  as  embolism) 
or  cerebral  occlusion  from  vascular  disease  ;  or  as  a  senile 
condition  connected  with  extensive  and  general  arterial  degen- 
eration. The  niost  striking  symptom  of  dementia  is  the 
weakness  of  memory,  which  deepens  so  that  the  individual  is 
practically  shut  out  from  the  past  and  cannot  remember  what 
he  has  heard,  or  what  he  has  done  a  few  minutes  before.  In 
cases  of  mania  or  melancholia  the  loss  of  memory  marks 
the  transition  into  dementia.  Dementia  is  always  characterized 
by  an  extreme  weakness  of  mental  action  which  gives  his  ex- 
pression a  feebleness  which,  is  manifested  in  Avavering  play  of 
worn  out  emotions,  incoherence  and  half- formed  and  varying 
delusions.  His  excitement  is  fitful  and  like  the  sputter  of  an 
expiring  candle  flame,  or  the  combustion  of  a  dampened  squib. 
He  is  ill  at  rest,  cannot  concentrate  his  mind  upon  the  subject 
of  the  present  and  cannot  connect  his  thoughts,  and   it  is  im- 


2&  MEDICAL   JURISPRUDENCE. 

possible  for  him  to  clearly  recognize  the  relation  of  an  idea 
with  others  that  have  preceded  it.  As  Browne  says  :  "  Famil- 
iar objects  are  not  recognized  ;  places -in  which  he  has  resided 
are  mistaken  for  other  places  ;  times  are  forgotten  ;  the  future 
is  not,  the  present  is  a  haze,  the  past  is  dim.  He  cannot  keep 
these  shades  separate  from  one  another.  He  confounds  the 
past  of  to-day  with  the  past  of  yesterday." 

The  delusions  most  characteristic  of  dementia  are  those  of 
suspicion.  A  dement  before  his  mental  condition  reaches  the 
last  stage  is  distrustful,  doubting  and  full  of  fears.  He  may 
believe  he  is  beaten  or  maltreated,  but  his  delusions  are  rarely 
elaborate  ;  unlike  the  melancholiac  he  cannot  go  through  with 
the  details  of  a  gigantic  conspiracy,  for  this  would  require 
much  greater  mental  strength.  His  hallucinations  are  com- 
mon, and  they  are  of  the  simplest  kind,  and  usually  so  unreas- 
onable as  to  attract  the  attention  of  the  lay  observer.  In  this 
respect  they  resem.ble  to  some  extent  those  of  acute  alcoholism, 
except  there  is  little  of  the  personality  of  the  latter. 

The  incoherence  of  dementia  differs  from  that  of  mania  in 
the  fact  that  in  the  former  there  is  a  paucity  of  ideas  and  the 
patient  becomes  demoralized  in  his  attempt  to  associate  and 
connect  them.  In  mania  the  loquaciousness  and  incoherence 
arise  from  the  excitement  and  liveliness  of  mental  action — the 
ideas  are  formed  much  more  rapidly  than  they  can  be  expressed. 

The  dement  shows  his  condition  in  the  vacancy  of  facial  ex- 
pression the  lack-lusterless  eyes  which  are  often  suffused  with 
tears,  and  commonly  he  exerts  himself  but  little. 

Secondary  Dementia  iQW.o-^%  organic  diseases  of  the  brain — 
which  may  be  slow  in  appearance.  Such  mental  enfeeblement 
may  anticipate  the  conspicuous  nervous  lesion,  the  cerebral 
hemorrhage,  thrombosis  or  embolism  and  be  manifested  by  loss 
of  memory,  irritability  or  aphasia,  or  it  may  follow  the  accidents 
I  have  mentioned.  In  the  first  case  the  arterial  degeneration 
is  slow  and  the  mental  defects  are  sometimes  unnoticed.  A 
case  in  which  the  question  of  testamentary  capacity  was  con- 
sidered lately  came  under  my  notice,  the  patient  being  an  old 
man  who  first  manifested  mental  symptoms  a  week  before  an 
attack  of  hemiplegia.  Upon  the  day  his  mental  disturbance 
became  conspicuous  he  made  many  blunders  in  nis  business, 
such  as  paying  his  employees  more  than  their  wages,  and  not 
knowing  his  mistakes  until  reminded  ;  making  an  important  en- 
gagement in  the  morning  and  not  knowing  any  thing  about  it  in 
the  afternoon,  as  well  as  a  series  of  trifling  neglects  of  various 
kinds.     A  week  later  he  had  an  attack  of  hemiplegia,  followed 


GENERAL    CONSIDERATION.  27 

by  two  Others  and  died  in  a  month.  His  mind  gradually  be- 
came weaker  and  weaker,  his  memory  more  feeble,  and  he  died 
in  a  condition  of  coma. 

Other  cases  are  less  rapid  and  their  course  is  marked  by  a 
gradual  exhibition  of  mental  weakness  which  goes  hand  in 
hand  with  physical  decay.  The  dementia  of  syphilis  is  an  ex- 
ample of  this  kind — the  stupidity,  however,  being  more  marked 
than  in  other  varieties.  The  syphilitic  dement  is  apt  to  pre- 
sent in  addition  to  the  loss  of  memory,  which  is  quite  marked, 
and  a  tendency  to  somnolency,  various  symptoms  indicative 
of  organic  changes.  Localized  cranial  nerve  paralysis,  optic 
neuritis  and  convulsions  are  among  them,  or  it  sometimes  hap- 
pens that  a  rapidly  developing  dementia  complicated  at  some 
period  by  delusions  of  grandeur  is  presented,  whicli  at  the 
early  stage  may  resemble  general  paresis.  The  mental  enfee- 
blement  is  earlier,  however,  than  in  the  latter  disease,  and  more 
marked. 

When  dementia  succeeds  primary  forms  of  insanity  such  as  a 
mania  or  melancholia  it  is  secondary  or  consecutive.  Mania  runs 
much  more  frequently  into  dementia  than  does  melancholia. 

Bucknill  and  Tuke  divide  dementia  into  three  forms,  ^'Par- 
tial or  incipient^'  and  '''complete  or  confirmed^'  and  an  intermediate 
form. 

"ist.  Those  who,  whether  previously  well  or  insane,  are  grad- 
ually passing  into  a  decidedly  demented  condition.  Some  con- 
fusion of  thought,  a  perplexed  rather  than  stupid  expression, 
and  a  failing  memory,  are  the  most  obvious  symptoms.  Such 
patients  are  not  incoherent,  or  are  only  occasionally  so.  They 
are  sometimes  conscious  of  their  condition,  and  carefully  avoid 
committing  themselves.  They  can  read  and  write,  but  in  regard 
to  the  latter  it  will  be  found  that  after  composing  a  few  sentences 
correctly,  they  express  themselves  confusedly  and  spell  incor- 
rectly.    This  '\s  partial  or  incipient  Dementia. 

"  2d.  Those  who  are  so  far  advanced  that  they  cannot  tell 
their  names. — Many  of  this  class  are  dirty  in  their  habits. 
Their  time  is  mostly  spent  in  listlessness  or  muttering  to  them- 
selves, twirling  their  fingers  about  in  all  directions,  now  catch- 
ing up  something  from  the  ground  with  which  they  play  until 
some  fresh  fancy  seizes  them,  or  scraping  together  bits  of  paper, 
sticks,  strings,  stones,  etc.;  not  with  the  constructive  power  of 
the  child,  but  purposelessly  ;  or  if  otherwise,  only  with  the  mis- 
chievous propensity  of  the  magpie.  We  then  have  complete  or 
confir77ied  Dementia." 

Senile  Dementia  is  usually  attended  by  physical  debility  as 


28  MEDICAL    JURISPRUDENCE. 

well  as  mental  failure  which  conspicuously  betrays  itself  by 
impairment  of  the  memory  and  childishness.  The  senile 
dement  is  apt  to  repeat  himself,  as  the  same  worn-out  story 
is  told  over  and  over  again,  while  petty  incidents  of  former 
life  are  constantly  gone  over,  and  in  advanced  stages  the 
individual  is  unable  to  recollect  what  he  has  said  a  few  minutes 
before,  and  is  incoherent,  and  silly.  He  may.  perhaps  be. 
unable  to  remember  the  names  of  two  children,  but  mixes 
them  up.  He  is  ill  tempered  and  petulant.  There  is  a  pitiful 
lack  of  concentration  which  results  in  restlessness  of  mind  and 
body.  Sleep  is  broken  and  in  consequence  he  wanders  about 
the  house  at  night,  or  out  into  the  street  in  an  aimless  way, 
where  his  peculiar  behavior  may  lead  perhaps  to  his  arrest. 
Incontinence  of  urine  causes  him  to  wet  his  clothing  fre- 
quently and  he  gives  off  an  ammoniacal  odor.  The  old  man 
undergoes  a  moral  change  as  well  as  an  intellectual,  and  he  is 
amatory,  obscene,  and  fond  of  telling  of  the  adventures  of 
his  youth,  and  living  over  again  its  gallant  frivolities.  His 
leer  is  lascivious,  and  he  goes  about  with  unbuttoned 
clothing,  and  is  lost  to  all  shame.  He  is  extravagant  and 
prodigal,  and  buys  useless  things  despite  the  remonstrances  of 
his  friends. 

The  subjects  of  the  disease  are  often  elderly  men  who  have 
suddenly  freed  themselves  from  the  cares  of  business.  The 
reaction  which  idleness  entails  intensifies  the  tendency  to  mental 
enfeeblement  and  perversity. 

The  demented  old  man  sinks  into  a  condition  of  vegetative  life. 
The  mental  vacuity  and  helplessness  is  painful,  and  he 
gradually  sinks  and  dies  finally  of  exhaustion.  It  is  occasion- 
ally found  that  just  before  death  there  may  be  a  slight 
evidence  of  intelligence,  but  this  is  by  no  means  common. 

Melancholia. — Melanc/ioiia  is  an  asthenic  variety  of  insanity 
of  easy  recognition  and  of  variable  form,  and  is  much  more 
common  among  women  than  men.  It  may  be  acute  or  chronic, 
and  according  to  its  grade  has  received  a  variety  of  names.  The 
French  writers  descril^e  lypcniauie  which  corresponds  more 
closely  to  the  simple  melancholia  of  English  writers,  and  a 
severer  form  which  is  designated  stupiditd,  which  has  its  anal- 
ogue in  melancholia  attonita.  Still  further  subdivisions  are 
made  with  reference  to  the  predominance  of  religious,  erotic, 
hypochondriacal  or  other  ])rominent  characteristics.  Melan- 
cholia is  characterized  bv  a  state  of  despondency  and  may  be 
defined  as  '*  a  mental  affection  manifested   by  delirious  ideas 


GENERAL    CONSIDERATION. 


29 


of  a  sad  nature  and  by  a  depression  that  may  amount  to  stupor 
(Lutaud)." 

The  depression  may  be  of  a  passive  nature,  with  mental  and 
physical  relaxation,  and  with  utter  dejection  and  hopelessness, 
or  there  may  be  a  more  forcible  expression  of  mental  suffering, 
with  anxiety,  despair,  and  muscular  rigidity  and  some  excite- 
ment. As  in  mania  there  may  be  a  great  variety  of  insane 
hallucinations  and  delusions  expressed  by  the  patient,  but  these 
are  mostly  of  an  erotic  or  religious  character,  and  there  is  in 
nearly  every  case  a  history  of  persecution.  There  is  in  the 
beginning  after  a  prodromal  stage  of  bad  health  a  change  in  the 
patient's  habits  and  disposition.  A  naturally  happy  and  joyous 
person  becomes  sad,  reserved,  and  takes  little  interest  in  her 
surroundings.  There  may  be  an  oversensitiveness  and  a  sense 
of  personal  shortcomings,  and  a  feeling  of  self-deprecia- 
tion ;  the  patient  is  tortured  by  doubts  regarding  her  religious 
views  and  her  fitness  for  association  with  others.  She  may 
imagine  that  she  has  committed  some  unpardonable  sin,  or  that 
she  is  beyond  help.  She  will  not  go  to  the  communion  table, 
believing  her  presence  there  will  pollute  those  whom  she  may 
meet,  and  one  who  has  led  a  blameless  and  pure  life  may  con- 
sider herself  the  lowest  of  women.  In  other  cases  the  depress- 
ion exists  in  regard  to  more  worldly  things.  The  merchant  will 
believe  that  he  is  bankrupt,  that  he  is  dishonest,  or  that  he  is 
the  special  object  of  contempt  among  his  business  associates. 
Very  often  melancholia  arises  from  a  belief  that  the  individual 
is  in  a  hopeless  state  of  bodily  disease,  and  this  form  of  trouble 
may  follow  simple  hypochondriasis.  Delusions  of  persecution 
are  exceedingly  common,  and  in  fact  I  know  of  no  well  marked 
case  where  they  have  not  existed  at  some  time  or  other.  Under 
the  influence  of  hallucinations  or  delusions  the  melancholic 
patient  may  and  often  does  resort  to  suicidal  and  homicidal 
violence,  but  more  often  the  former,  and  such  demonstrations 
are  as  a  rule  unlooked  for.  Under  the  sway  of  delusions  of 
persecution  the  melancholiac  may  attack  imaginary  enemies  and 
at  this  stage  of  the  disease  should  be  carefully  watched,  for 
these  acts  are  commonly  impulsive,  and  though  in  the  begin- 
ning she  may  describe  her  feelings  and  promptings  and  no  at- 
tention may  be  paid  to  them,  she  may  to  the  astonishment  of  all 
commit  some  horrible  crime. 

The  disease  rarely  exists  in  an  uncomplicated  form,  but  is 
associated  with  excitement  and  may  alternate  with  attacks  of 
mania.  Dickson  very  properly  suggests  that  we  should  be  very 
careful  in  our  investigation  of  these  cases,  as  they  may  be  the 


30  MEDICAL    JURISPRUDENCE. 

basis  of  subsequent  legal  complications.  The  melancholic 
patient  pays  very  little  attention  to  her  bodily  wants,  if  the 
disease  be  at  all  well  marked.  May  refuse  food,  either  as  the  re- 
sult of  a  delusion  ])erhaps  that  she  is  being  poisoned  or  that  she 
can  live  without  it,  or  on  the  other  hand  from  entire  disregard 
of  life  and  its  duties,  and  it  may  be  necessary  to  use  forcible 
measures  to  compel  her  to  take  nourishment.  She  becomes 
dirty  in  her  habits,  soiling  her  clothes  and  paying  little  atten- 
tion to  the  appearance  she  presents.  With  disordered  hair  and 
averted  eyes  the  melancholiac  sits  by  herself  lost  in  her 
own  reflections,  although  there  are  some  who  are  communica- 
tive and  loquacious.  Physically  the  patient  reflects  her  mental 
disturbance  and  in  the  facial  expression  which  is  almost  too 
familiar  to  need  description.  As  a  rule  the  physiognomy  is  of 
a  simple  kind.  The  face  is  pinched  and  wan  and  unnaturally 
pale,  the  eyelids  droop,  and  the  facial  folds  are  dependent  ;  the 
lips  are  bloodless,  the  pupils  a:e  dilated  and  everything  indi- 
cates inaction.  The  hands  are  livid  and  hang  idly,  and  the 
maintainence  of  a  fixed  position  sometimes  for  hours  at  a  time  is 
characteristic  of  the  intellectual  torpor.  The  subject  of 
anxious  melancholia  is  restless,  the  manner  may  be  excited 
and  full  of  energy,  and  she  betrays  in  her  facial  expression  the 
mental  suffering  incident  to  her  torturing  doubts  and  fears. 

Simple  Melancholia. — In  medico-legal  cases  we  are  often 
called  upon  to  distinguish  between  simple  melancholia  without 
delusions  and  the  more  serious  forms  where  there  is  much  beside 
the  depression.  In  the  latter,  volitional  control  is  often  inter- 
fered with  or  lost,  and  this  may  arise  from  the  false  belief  in  per- 
secution, or  some  other  such  indication  of  intellectual  perver- 
sion. If  crimes  are  committed  as  the  result  of  simple  melan- 
cholia, suicide  seems  to  be  the  most  common,  dnd  this  may  be 
due  to  utter  dejection  and  hopelessness,  and  an  unwarranted 
belief  that  there  can  be  no  change  for  the  better.  In  such 
cases  the  most  ordinary  physical  disturbance  is  exaggerated 
into  a  incurable  malady,  and  hypochondriasis  is  a  complicated 
condition. 

Mania. — Mania  is  a  form  of  mental  disease  accompanied  by 
more  or  less  excitement  and  is  acute  or  chronic.  Most  authors 
divide  it  into  general,  intellectual,  and  moral,  and  moral  mania 
is  again  divided  into  general  and  partial.  The  two  important 
divisions  however  are  acuiea.v\6  chronic,  and  the  other  terms  are 
only  convenient  as  fixing  predominant  features  of  an  attack  of 
active  insanity. 


General  consideration.  31 

'  Mania  begins  by  changes  in  the  patient's  habits  and  disposi- 
tion, and  may  at  first  be  poorly  marked,  but  afterwards  mani- 
fests itself  in  attacks  of  violence.  The  acute  maniac  is  in  a 
constant  state  of  restless  activity  which  is  expressed  in  sudden 
and  rapid  muscular  movements,  and  he  undergoes  great  fatigue 
without  complaint.  The  eyes  are  bright  and  injected,  the  face 
flushed,  tlie  hair  bristling,  the  temperature  heightened,  and  the 
pulse  smaller  and  rapid.  The  urine  is  scanty  and  loaded  with 
urates,  and  the  tongue  is  glazed  and  red.  Such  a  patient  is 
violent,  destructive,  and  tears  his  clothing,  or  breaks  articles  of 
furniture.  He  eats  ravenously  and  is  apt  to  help  himself  not  only 
from  his  own  plate,  but  from  the  dishes  upon  the  table.  He 
is  voluble  and  usually  incoherent  and  emotionally  excited.  In 
some  cases  of  mania  as  well  as  melancholia  the  derangement 
seems  to  be  almost  confined  to  the  intellectual  faculties  and  it 
is  this  fact  that  has  led  to  the  adoption  of  the  term  Intellect- 
ual Insanity.  Ray  and  others  believing  that  derangement  may  be 
limited  to  one  or  more  faculties,  speak  of  partial  moral  mania 
or  monomania.  Mania  and  melancholia  are  symptomatic  condi- 
tions after  all,  and  may  exist  not  only  by  themselves  but  as  sec- 
ondary or  intercurrent  complications  of  coarse  brain  disease  or 
even  imbecility  or  idiocy.  (Ogston).  This  irregularity  and 
inconsistency  in  the  expression  of  insane  symptoms  have  led  to 
the  greatest  difference  of  opinion.  It  should  be  borne  in  mind, 
however,  that  an  ordinary  case  of  mania  at  different  stages 
may  be  designated  not  only  as  "  monomania."  but  "  partial  " 
or  ''  moral  "  insanity  by  those  who  look  upon  the  case  super- 
ficially. The  morbid  moral  changes  are  displayed  m  perversion 
of  natural  feelings,  appetites,  habits  and  impulses.  These  may 
be  prominent,  and  for  a  time  disconnected  from  any  marked 
hallucination  or  delusion.*  Then  mania  is  manifested  by  cer- 
tain forms  of  moral  perversion  and  we  apply  a  variety  of  terms. 

Kleptomania. — Kleptomania  for  instance  enters  into  the 
history  of  certain  cases  of  insanity,  and  consists  of  a  propen- 
sity for  theft.  In  itself  I  do  not  think  we  are  justified  in  con- 
sidering this  necessarily  as  insanity.  It  is  only  when  useless 
gew-gaws  and  trifles  are  stolen,  that  the  matter  should  be 
looked  upon  seriously.  When  the  theft  is  connected,  with 
secretiveness  there  is  usually  something  wrong.  I  can  recall 
the  case  of  a  well-to-do  lady  who  appropriated  a  great 
number  of  trifles  such  as  children's  small  china  dolls,  pencils, 
bits  of  worsted,  and  a  variety  of  small  objects  which  she  filched 
from  the  shops  she  visited.     Wlicn  Ivm-  irc.mitv  assumed  a  well 

*(See  Appendix  B,  Primary  Delusional  Insanity.) 


32  MEDICAL    JURISPRUDENCE. 

marked  form  and  she  was  less  careful,  these  objects  were  found 
wrapped  up  in  bits  of  rag  and  paper,  and  stowed  away  in  all 
sorts  of  out  of  the  way  places  in  magpie  fashion.  Klepto- 
mania has  been  spoken  of  as  a  consequence  of  disor- 
dered menstruation,  as  a  phase  of  idiocy,  as  a  feature  of 
the  so-called  lucid  interval,  and  as  of  occurrence  in  mania. 
It  is  not  safe  in  courts  of  law  to  testify  positively  as  to 
the  insane  character  of  certain  thefts,  without  we  find  there 
have  been  some  other  manifestations,  for  the  morbid  propensity 
to  steal  cannot  be  looked  upon  as  an  isolated  symptom. 

Pyroniailiil. — Pyromania  or  the  mania  for  burning  is 
another  form  of  moral  perversion  occurring  in  connection 
with  mania.  I  have  found  it  to  be  a  feature  of  certain  varieties 
of  epileptic  insanity  occurring  with  mental  weakness.  There 
is  a  boy  at  the  Hospital  for  epileptics  and  ])aralytics  who  has 
repeatedly  attempted  to  set  fire  to  the  wooden  pavilion  where 
he  and  his  fellow  patients  are  kept.  Under  the  influence  of 
delusions  we  sometimes  find  that  mothers  will  attempt  to  burn 
their  children  by  setting  fire  to  their  clothing,  or  will  commit 
destructive  acts  with  fire  as  the  result  of  various  promptings. 

A  well  known  instance  of  pyromania  to  be  found  in  the 
books  is  that  of  Martin  who  attempted  to  set  fire  to  York  Cathe- 
dral. 

It  is  rare  for  this  tendency  to  be  found  alone  and  it  is  usually 
connected  with  suicidal  and  homicidal  impulses,  and  fire  is 
used  for  the  destruction  of  the  patient  or  his  victim. 

An  interesting  American  case*  in  which  pyromania  was  urged 
as  the  defense,  was  that  of  Speir,  who  set  fire  to  the  Utica 
asylum.  He  had  been  committed  \j  the  asylum  upon  the  or- 
der of  a  judge,  but  discharged  subsequently,  it  having  been 
doubtful  whether  he  had  ever  been  really  insane.  After  his 
discharge,  it  was  found  that  the  several  acts  of  arson  committed 
were  the  result  of  personal  pique  and  although  of  a  vicious  turn 
he  was  not  insane. 

A  case  of  a  different  kind  is  that  of  Nathaniel  Greemont,  of 
Danbury,  Connecticut,!  a  young  man  of  previous  good  charac- 
ter who  attempted  to  burn  the  whole  village,  but  when  he  had 
destroyed  two  barns  was  arrested  after  confession  of  his  crime. 
He  claimed  to  have  an  accomplice,  but  this  was  subsequently 
shown  to  be  a  delusion.     It  was  shown  that  he  was  an  epileptic 

*  American  younial  of  Insanity,  Vol.  xv. ,  No.  ii,  p.  200, 

flbid  Vol.  v.,  No.  iii,  p.  237. 


GENERAL    CONSIDERATION.  33 

and  that  he  presented  physical  peculiarities,  his  head  being  un- 
usually small,  in  fact  he  presented  the  indication  of  epileptic 
insanity.  Throughout  the  trial  he  manifested  great  unconcern. 
He  was  discharged  the  jury  failing  to  agree  upon  a  verdict. 

"A  young  girl  of  less  than  fifteen,  named  Grabowska,  afflicted 
with  nostalgia,  twice  set  fire  to  the  house,  in  order  to  quit  her 
masters.  She  declared  that  from  the  moment  she  entered  their 
service  she  was  unceasingly  possessed  with  the  desire  to  burn 
the  place.  It  seemed  to  her  that  a  specter  continually  before 
her  impelled  her  to  the  act.  It  was  noticed  that  this  girl  for  a 
long  time  suffered  from  violent  headache  and  that  menstruation 
was  behindhand."* 

Dipsomania  has  been  applied  to  the  form  of  insanity 
which  is  manifested  by  a  craving  for  alcohol.  In  cases  of 
this  kind  the  question  whether  the  inordinate  appetite  for 
drink  is  a  result  or  a  cause  of  the  insanity  is  to  be  deter- 
mined, and  one  of  the  most  important  and  common  ques- 
tions that  arise,  especially  in  criminal  trials,  is  whether  a 
specific  act  is  the  result  of  intoxication  or  whether  it  is 
a  genuine  insane  delusion.  In  a  subsequent  chapter  I  will 
discuss  the  medico-legal  relations  of  alcoholism,  and  it 
only  remains  here  to  call  attention  to  a  sudden  change  of 
habit  which  occurs  in  people  who  before  were  temperate  and 
useful  members  of  society.  It  sometimes  happens  that  an  indi- 
vidual who  has  borne  an  irreproachable  character,  the  head  of 
a  family  or  a  church,  will  suddenly  tvith  other  changes  develop 
an  inordinate  craze  for  liquor.  He  will  plunge  into  violent 
excesses  which  will  last  for  a  time,  and  then  he  may  suddenly 
cease  his  orgies  and  for  a  considerable  period  lead  a  blameless 
life  until  the  next  period  when  he  repeats  his  excesses.  Forms 
of  sudden  moral  change  with  mania  or  melancholia  are  always 
grave  and  should  be  looked  into. 

When  the  dipsomaniac  drinks  he  does  so  without  any  con- 
sideration of  conviviality  ;  he  does  not  care  for  liquor  during 
the  remission  of  his  disease,  and  will  not  take  it  if  placed  be- 
fore him  or  offered  to  him. 

The  female  dipsomaniac  is  more  apt  to  crave  drink  during 
her  menstrual  periods,  and  the  appetite  may  suddenly  dis- 
appear after  the  cessation  of  the  particular  period.  When  the 
condition  occurs  after  sunstroke  or  injuries  to  the  head  the 
diagnosis  from  ordinary  drunkenness  may  be  made  out. 

Suicidal  Mania  is   one  of    the    most    common  forms  of 

•"■Foxbes  Winslow's  Journal,  of  Psychological  Journal,  N<A.  xiv. 
1 


34  MtDICAL    JURISPRUDENCE. 

mental  derangement  in  which  the  moral  change  is  marked. 
The  existence  of  a  dominant  depressing  delusion  may  con- 
stantly suggest  insanity,  or  there  may  be  nothing  of  the 
kind,  there  being  only  a  constant  impulse  to  commit 
suicide  for  no  reason  whatever.  In  some  of  these  cases 
the  intellectual  aberration  may  be  very  slight,  and  no 
indication  of  the  patient's  real  state  of  feeling  is  manifested. 
A  man  apparently  in  the  full  possession  of  his  faculties  may 
blow  out  his  brains  or  jump  into  the  river,  and  those  left 
behind  are  filled  with  wonderment  and  unable  to  account  for 
the  motive.  Some  of  the  individuals  whose  impulse  is  not 
strong  enough  to  lead  them  to  extreme  measures  are  able,  upon 
recovery,  to  refer  to  the  period  when  they  purposely  avoided 
all  agents  with  which  they  might  make  away  with  themselves, 
and  have  spoken  of  their  terrible  temptations. 

Forbes  Winslow  and  others  have  referred  to  numerous  cases 
where  the  delusion  has  been  that  it  was  necessary  to  make 
some  such  sacrifice  to  gain  admission  to  heaven,  or  an  insane 
hallucination  has  been  the  basis  of  the  mental  state  leading  to 
the  suicide. 

The  question  of  suicide  is  often  considered  in  relation  to 
life  insurance  policies.  It  cannot  be  denied  that  a  perfectly 
sane  man  may  destroy  himself  for  what  he  really  believes  to  be 
a  holy  end,  the  prevention  of  suffering  or  to  avert  an  impend- 
ing calamity  that  will  .ruin  his  family,  just  as  a  soldier  goes  into 
battle  from  patriotic  motives,  or  a  miner  or  sailor  gives  up  his 
life  in  a  "forlorn  hope."  It  is  well  therefore  to  distinguish 
whether  the  insured  man  is  insane  when  he  makes  away  with 
himself  or  whether  he  dies  by  his  own  hands,  that  his  family 
shall  receive  the  amount  of  his  life  insurance  policy.  The 
method  of  suicide  should  be  considered,  his  relation  with  his 
family,  change  in  his  habits  and  way  of  business.  Hereditary 
taint  is  an  important  question,  and  Bucknill  and  Tuke  refer  to 
the  fact  that  many  interesting  cases  are  on  record  showing  the 
inherited  tendency, 

Falret  reports  the  case  of  a  young  woman  who  became 
melancholic  from  the  knowledge  that  an  uncle  had  committed 
suicide  by  his  own  hands,  and  under  the  delusion  that  her  blood 
was  corrupted  attempted  the  act  of  self-destruction.  Winslow 
refers  to  a  case  of  the  same  kind  :  A  few  months  ago  I  was 
called  to  see  a  young  lady  whose  two  uncles  had  taken  their 
lives  and  whose  father  had  made  a  similar  attempt.  She  knew 
nothing  of  all  this,  yet  when  laboring  under  melancholia  made 
desperate  and  repeated  altem^Ls  to  kill  herself,  and  upon  one 


GEiSTERAL    CONSIDERATION.  35 

occasion  was  found  with  her  throat  bared  and  a  number  of 
knives  and  razors  before  her. 

The  sexual  phase  of  insanity  should  always  receive  attention 
while  it  occurs  in  connection  with  other  phases  of  mental  dis- 
ease or  as  a  symptom  of  hysteria,  and  the  commission- of  an 
unnatural  crime  should  always  suggest  a  careful  examination 
of  the  patient's  antecedents  and  present  condition. 

Nymphomania  and  Satyriasis,  the  first  being  a  disease  of 
females,  the  latter  of  males,  are  symptomatic  conditions  and  are 
connected  with  emotional  excitement  rather  than  intellectual 
disturbance. 

Homicidal  Mania,  which  may  occur  in  the  course  of  any 
furm  of  insanity  is  sometimes  a  predominant  feature  of  this 
particular  mental  derangement,  and  is  often  concealed  or 
masked.  For  this  reason  many  horrible  crimes  have  been 
committed  by  persons  who  had  not  been  suspected  of  any 
thing  but  slight  derangement  which  did  not  call  for  their 
confinement,  or  sometimes  were  not  believed  to  be  insane  at 
all.  The  recent  case  of  Dobourque,  the  insane  French- 
man, who  rushed  through  a  crowded  street  stabbing  right 
and  left  with  a  pair  of  steel  dividers,  is  a  startling  example. 
He  had  been  regarded  only  as  a  person  of  eccentric  habits, 
harmless  for  years,  and  wandered  about  without  restraint  ; 
just  as  most  of  these  cases  are,  he  was  seized  with  an  impulse 
which  led  to  the  death  of  two  or  more  of  the  many  unsus- 
pecting women  he  struck. 

I  am  not  disposed  to  grant  that  in  such  cases  this  is  simply  a 
perversion  of  the  moral  faculties  while  the  intellectual  are  in  a 
normal  condition.  In  the  majority  of  cases  the  development 
of  the  murderous  tendency,  and  the  intellectual  derangement 
is  slow,  and  not  the  flash  from  a  clear  sky.  A  long  course 
of  symptoms  indicative  of  cerebral  disturbance,  are  displayed  in 
various  little  changes  in  temper,  and  in  the  fact  the  sub- 
jects are  persons,  (usually  women)  who  are  or  have  been  hys- 
terical, hypochondriacal,  or  unbalanced  so  far  as  their  emotions 
are  concerned.  Epileptics  are  very  apt  to  have  such  impulses 
and  Ogston  refers  to  its  origin  as  the  result  often  of  a  peculiar 
condition  connected  with  pubescence  in  many  people  of  bad 
temper  with  poor  digestion.  In  a  case  of  hysterical  insanity  I 
recently  committed  no  one  supposed  the  young  girl  to  be  more 
than  engaged  with  her  own  ailments,  and  it  was  hinted  that  her 
incarceration  was  a  great  wrong.  She  was  found  a  few  days 
before   leaving   home  to    have  a  rope  concealed  beneath  her 


35  MEDICAL    JURISPRUDENCE. 

night  dress,  and  she  several  times  alluded  to  the  possibility  of 
the  nurse  to  whom  she  was  devotedly  attached,  being  found 
dead  in  the  morning.  "  How  strange  it  would  be,"  said  she  to 
her  attendant,  "  if  you  were  choked  to  death  during  the  night 
and  found  dead  in  your  bed  in  the  morning."  When  she 
parted  with  this  woman  at  the  asylum  she  buried  her  fingers  in 
her  throat,  meanwhile  kissing  her  affectionately.  Such  morbid 
impulses  are  characteristic  of  these  forms  of  irregular  mental 
trouble. 

Persistence  of  Suicidal  Attempts. — The  persistence  in 
the  suicidal  attempt  is  sometimes  remarkable.  I  have  lately 
seen  a  woman  whose  insanity  was  of  an  hysterical  char- 
acter and  her  jealousy  of  her  husband  was  something 
remarkable.  Not  only  did  she  for  years  dog  and  follow  him 
about,  but  she  would  not  allow  him  out  of  her  sight  except  in 
company  of  two  of  their  children.  She  insisted  upon  sewing  up 
his  underclothing  with  many  colored  silks,  so  that  he  should  be 
prevented  from  opening  them  and  prove  unfaithful  to  her 
without  being  detected.  The  development  of  mania  with 
moral  perversion  was  marked,  she  was  excited,  cursed,  and  used 
obscene  language,  and  finally  became  suicidal.  Three  separate 
attempts  were  made  in  one  day — at  one  time  she  rushed  to  the 
window  and  tried  to  throw  herself  out  ;  the  second  attempt 
was  made  to  sever  her  wrist  with  a  knife,  which  was  too  dull,; 
however  ;  in  the  third  she  placed  her  head  in  an  open  grate 
and  was  severely  burned.  She  could  assign  no  motive  for  the 
act. 

Homicide  as  the  Result  of  Hallucination.— Homici- 
dal mania  may  lead  to  the  commission  of  an  act  of  violence  as  a 
direct  result  of  hallucination  or  insane  delusions,  such  halluci- 
nations or  delusions  bemg  either  a  i)rimary  element  in  the  sugges- 
tion of  the  act,  or  a  result  of  the  diseased  propensity.  Bucknill 
and  Tuke  direct  especial  attention  to  the  fact  that  the  morbid 
moral  tendency  is  as  important  in  coloring  the  hallucination 
as  the  actual  intellectual  suggestion.  In  other  words  a  person 
may  kill  another  because  he  delusively  believes  that  the  other 
intends  his  destruction,  or  he  may  kill  him  simply  because  his 
morbid  propensities  impel  him  to  kill  some  one  for  no  reason 
whatever  except  it  perhaps  may  be  the  i)leasure  of  seeing  blood, 
or  executing  his  fell  purpose.  A  case  of  the  latter  kind  is  that 
of  Jesse  Pomcroy,  the  Massachusetts  boy-murderer,  who  tor- 
tured and  murdered  small  children  for  the  simple  gratification 
it  cave  him. 


GENERAL    CONSIDERATION.  37 

Homicidal  Mania  with  or  without  Delusions. — That 
there  is  an  underlying  intellectual  perversion  even  in  these 
cases  I  have  no  reason  to  doubt.  For  convenience  we  may- 
classify  homicidal  insanity  as  follows  : 

1.  Cases  in  which  the  act  is  the  result  of  an  insane  delusion. 

2.  Cases  in  which  the  act  is  apparently  purposeless  (so-called 
moral  insanity)  and  in  which  there  is  usually  some  emotional 
excitement. 

Bucknill  and  Tuke  in  an  analysis  of  cases  present  50  exam- 
ples.    These  are  divided  into  : 

I.  Without  marked  disorder  of  the  intellect  : 

(a)  Without  premeditation  or  design,  31 

{^)  With  premeditation  or  design,  4 

—  35 

II.  Cases  m  which  there  was  more  or  less  disorder  of 

the  intellect : 

{a)  With  deficiency  of  intellect,  5 

{3)  With  delusions,  etc.  10 

—  15 
Total,  50 

It  would  appear  from  this  table  that  the  prominence  of  gen- 
eral intellectual  disorder  was  not  great,  for  the  majority  of 
cases  are  of  the  impulsive  variety — but  these  statistics  refer 
only  to  the  nature  of  the  act  which  may  have  been  committed 
at  a  stage  when  the  presence  of  delusion  or  intellectual  dis- 
turbance was  not  pronounced. 

Premeditation. — The  insane  often  show  great  ingenuity 
in  the  execution  of  their  crimes.  They  are  able  to  scheme 
and  plot  and  exercise  an  amount  of  reasoning  power  which 
usually,  however,  arises  from  idi\?,Q premises  and  eventuates  in  the 
commission  of  an  act  which  in  no  way  jielps  the  patient,  and 
which  he  would  never  do  in  health. 

"A  man  aged  32,  a  laborer  of  no  education,  no  religious 
belief,  of  bad  habits,  became  the  subject  of  chronic  mania 
following  prolonged  ill-health  ;  killed  the  adopted  son  of  his 
brother-in-law  by  repeated  stabs  with  a  pitch-fork  and  knife. 
The  murder  was  premeditated,  well-arranged  plans  of  conceal- 
ment were  laid  and  carried  out,  the  instruments  were  carefully 
washed,  and  the  body  buried  under  the  barn.  His  motives  were 
grounded  in  personal  hatred  and  revenge.  He  had  always 
borne  the  reputation  of  being  a  bad  man.  The  act  was  com- 
mitted in  the  daytime.  Demented,  and  after  nineteen  years 
was  removed  to  the  County  Asylum." 


38  MEDICAL   JURISPRUDENCE. 

In  this  case  there  is  just  enough  to  create  a  doubt  of  his 
insanity  in  the  lay  mind.  The  common  idea  that  lunatics  cannot 
reason,  and  the  prisoner's  previous  bad  character  and  revengful 
motives  were  against  him,  but  the  subsequent  termination  of 
his  disease  gives  the  case  a  different  light.  Many  lunatics 
com.mit  acts,  however,  for  which  they  are  entirely  responsible, 
and  while  insane  in  other  ways  are  perfectly  capable  of  knowing 
the  difference  between  right  and  wrong,  and  Winslow  refers 
to  a  confirmed  chronic  maniac  who  was  overheard  to  say  :  "  If 
I  were  to  set  fire  to  the  asylum  they  would  not  punish  me  for 
it,  for  I  am  insane." 

Cunning  of  the  Insane. — A  patient  of  my  own  had  been 
the  subject  of  melancholy  for  some  time,  but  no  one  suspected 
any  dangerous  form  of  insanity.  She  managed,  however,  to 
coax  her  sister  into  her  room,  and  when  there  turned  the  key 
and  sprang  upon  her  and  would  have  killed  her  had  help  not  come. 
Dr.  Gray  had  under  his  care  "an  educated  woman  and  mother 
of  a  large  family.  Was  of  an  amiable  and  gentle  disposition, 
but  sank  into  melancholia  at  the  climacteric  period.  There 
was  a  strong  hereditary  taint  in  her  family.  One  night  she  re- 
quested to  sleep  at  the  front  of  the  bed,  which  was  permitted. 
On  retiring,  she  drew  a  small  stand  to  the  bedside,  and  when 
she  supposed  her  husband  asleep,  cautiously  took  a  razor, 
which  she  had  concealed  in  a  drawer  of  the  stand,  and  drew  it 
across  his  throat.  He,  however,  had  not  been  asleep,  and  re- 
sisted ;  she  then  cut  her  own  throat ;  she  never  spoke  after- 
ward, but  continued  very  suicidal  to  the  day  of  her  death, 
which  occurred  about  six  months  after." 

I  mention  these  cases  to  show  how  lay  witnesses  may  be  de- 
ceived, and  how  easy  it  is  for  a  person  to  derive  a  wrong  idea 
of  a  really  serious  case  and  perhaps  so  testify. 

The  persistence  of  certain  lunatics  in  their  homicidal  at- 
tempts even  when  every  precaution  is  taken,  is  well  illustrated  in 
the  following  case  rei)orted  by  Gray  :  "Man,  aged  27,  German, 
member  of  Lutheran  church,  of  good  education,  a  musician  by 
profession  ;  was  married  to  a  lady  of  great  personal  beauty,  his 
superior  physically,  and  to  whom  he  had  been  long  and  tenderly 
attached.  Some  months  after  marriage  he  made  an  attempt  to 
push  her  into  the  canal,  and  also  into  the  river.  After  several 
attempts  of  this  kind,  she  demanded  his  reasons  for  such  strange 
conduct  ;  he  burst  at  once  into  a  paroxysm  of  weeping,  mingled 
with  the  fondest  expressions  of  endearment,  and  an  obscure  re- 
ference to  the  bliss  of  heaven.     She  concluded  that  he  was  be- 


GENERAL    CONSIDERATION.  39 

coming  insane,  and  that,  under  some  delusion,  he  desired  to 
kill  her,  and  afterwards  take  his  own  life  ;  wishing  to  avoid  the 
shame  and  despair  of  such  an  exposure,  she  courageously  deter- 
mined to  keep  the  secret,  and  rely  upon  her  own  strength  and 
presence  of  mind  to  prevent  the  accomplishment  of  his  purpose. 
He  was  paler  than  usual,  and  suffered  from  headache,  but  was 
able  to  discharge  his  accustomed  duties.  He  continued  his  at- 
tempts, his  wife  searching  him  every  night,  often  finding  a  brace 
of  pistols,  a  razor,  a  carving-knife,  then  locking  the  door  and 
securing  the  key.  It  occurred  to  her  that  traveling  might 
benefit  him,  and  they  accordingly  started  to  visit  some  friends 
at  the  West.  On  board  the  steamboat,  crossing  Lake  Erie, 
he  was  most  persistent  in  his  efforts  to  induce  her  to  walk  with 
him  on  the  upper  deck,  and  did  not  cease  begging  to  have  her 
do  so  until  midnight,  and  then  cried  himself  to  sleep.  Having 
nothing  to  do,  his  attempts  only  increased  in  frequency.  They 
retired  one  night,  after  a  most  careful  search,  as  usual ;  when 
about  half  asleep  she  was  aroused  by  feeling  the  edge  of  a  razor 
drawn  across  her  throat.  By  combining  great  presence  of  mind 
with  all  the  strength  she  could  summon,  she  escaped  with  an 
extensive  but  fortunately  superficial  wound  ;  and  to  use  her  own 
language,  'thinking  it  about  time,'  she  brought  him  to  the 
Asylum.  There,  one  of  his  first  acts  was  to  conceal  a  razor. 
His  disease  was  dementia.  He  soon  recovered,  and  subse- 
quently acknowledged  that  his  sole  and  engrossing  aim  was  to 
kill  his  wife,  and  then  himself,  to  secure  the  mutual  enjoyment 
of  heavenly  bliss ;  thinking,  as  he  expressed  it  with  eyes 
dancing  with  delight,  'if  we  were  so  happy,  happy  here,  what 
would  it  be  in  heaven  ! '  His  object  in  concealing  the  razor 
was  to  cut  his  wife's  throat  the  first  time  she  should  be  per- 
mitted to  visit  him,  and  then  his  own." 

Cases  of  homicidal  insanity  are  mentioned,  in  which  the  mo- 
tive given  by  the  murderer  is  that  the  victim  is  to  be  spared 
future  torment  and  misery.  In  one  case  mentioned  by 
Winslovv — that  of  Sarah  Grant,  who  murdered  her  boy  by 
cutting  off  his  head  with  a  bill-hook  and  almost  killed  two 
others  in  the  same  way, — the  prisoner,  when  arrested,  con- 
fessed that  she  had  done  the  deed  because  she  believed  that  all 
her  children  were  going  to  hell.  In  this  case,  as  in  many  others, 
there  is  a  suicidal  tendency  upon  the  part  of  the  patient.  I 
have  known  of  several  such  cases  and  in  each  case  the  horrible 
nature  of  the  act  is  increased  by  the  fact  that  its  execution  is  ac- 
complished in  the  most  cold-blooded  and  brutal  manner. 

Gray  reports  the  following  cases,  which  are  of  a  common  type  : 


40  MEDICAL    JURISPRUDENCE. 

"Woman,  aged  46,  married,  five  children,  temperate.  Had 
attack  of  melancholia,  with  depressing  ilelusions.  Said  her 
children  would  all  get  sick  and  die,  and  that  all  would  die  to- 
gether within  twenty-four  hours.  Soon  after  this  seized  one  of 
her  children,  a  daughter,  and  attempted  to  cut  her  throat,  was 
prevented  by  others.  Afterward  she  tried  to  dash  her  own 
brains  out  against  a  stone  wall.  She  had  an  appreciation  of 
her  condition  and  gave  her  own  history.  She  was  discharged 
after  about  nine  months,  in  an  improved  condition." 

"Woman,  aged  35,  married,  temperate.  Had  suffered  from 
melancholia  for  more  than  a  year  and  was  very  much  depressed, 
said  she  was  tired  of  life  and  did  not  wish  to  leave  her  boy  be- 
hind her.  She  attempted  to  kill  him  by  cutting  his  throat, 
wound  severe  but  not  dangerous^  then  tried  to  cut  her  own 
throat,  but  desisted  before  she  inflicted  severe  wounds.  With- 
in a  month  was  brought  to  the  Asylum,  where  she  recognized 
her  condition  and  said  that  at  the  time  she  was  insane.  She 
was  thin  and  anemic,  but  regained  her  health,  and  in  a  few 
months  was  discharged  recovered." 

Reasoning  Homicidal  Insanity. — The  reasoning  power 
of  the  insane  is  sometimes  remarkable.  The  following  case  is 
one  in  which  a  woman  attempted  a  homicide  after  a  process  of 
ratiocination  having  for  its  basis  a  delusion,  and  her  motive  be- 
ing the  desire  to  prove  the  truth  of  her  original  delusion  : — 

"  A  woman  about  thirty-six  years  of  age,  who  had  been  well- 
educated,  but  whose  conduct  had  not  been  exempt  from  some 
irregularities  in  consequence  of  intemperance  and  manifold  dis- 
appointments, became  affected  with  madness. 

"  She  was  by  turns  furious  and  melancholic,  and  conceived 
she  had  murdered  one  of  her  children,  for  which  she  ought  to 
suffer  death.  She  detailed  the  manner  in  which  she  had 
destroyed  the  child  and  the  motives  which  actuated  her  so  cir- 
cumstantially and  with  so  much  plausibility  and  feeling,  that  if 
it  had  not  been  known  that  her  child  was  living,  the  ])hysician 
under  whose  care  she  was  placed  might  have  been  deceived. 
By  her  own  hands  she  had  repeatedly  endeavored  to  terminate 
her  existence,  but  was  prevented  by  constant  vigilance  and  due 
restraint.  Her  disposition  to  suicide  was  afterwards  relinquished, 
but  she  still  insisted  that  for  the  murder  of  the  child  she  ought 
to  suffer  death  and  requested  to  be  sent  to  Newgate  in 
order  to  be  tried  and  undergo  the  sentence  of  the  law  ;  indeed, 
she  appeared  to  derive  consolation  from  the  hope  of  becoming 
a  public   example  and  expiating  her  supposed  crime  on   tlie 


GENERAL    CONSIDERATION,  41 

scaffold.  While  in  this  state,  and  with  a  hope  of  convincing  her 
of  its  safety,  the  child  was  brought  to  visit  her.  When  she  be- 
held it  there  was  a  temporary  burst  of  maternal  affection  ; 
she  kissed  it  and  for  a  few  moments  appeared  to  be  delighted. 
But  a  look  of  suspicion  quickly  succeeded,  and  this  was 
followed  by  a  frown  of  indignation,  which  rendered  the 
removal  of  the  child  a  measure  of  wholesome  necessity.  Per- 
haps in  no  instance  was  the  buoyancy  of  madness  more  con- 
spicuous over  reason,  recollection,  and  feeling.  She  insisted 
they  had  attempted  to  impose  on  her  a  strange  child,  which 
bore  a  faint  resemblance  to  her  own  ;  however,  by  such 
subterfuges  she  was  not  to  be  deceived  ;  she  had  strangled  the 
child  until  life  had  totally  departed,  and  it  was  not  in  the  order 
of  nature  that  it  should  exist  again.  The  effect  of  this  interview 
was  an  exasperation  of  her  disorder  ;  she  became  more  cun- 
ning and  malignant,  and  her  desire  for  an  ignominious  death 
was  augmented.  To  render  this  more  certain  and  accelerate 
her  projected  happiness,  she  enticed  into  her  apartment  a  >oung 
female  patient,  to  whom  she  appeared  to  be  attached,  and  hav- 
ing previously  plaited  some  threads  of  her  bed-quilt  into  a  cord, 
she  fixed  it  round  the  neck  of  the  young  woman  and  proceeded 
to  strangle  her.  Fortunately  some  person  entered  the  room  and 
unloosed  the  cord  in  time  to  save  her.  When  this  unhappy 
maniac  was  questioned  concerning  the  motive  which  induced 
her  to  attempt  the  destruction  of  a  person  for  whom  she  had 
manifested  kindness,  she  very  calmly  replied  that  as  the  mur- 
der of  her  own  child  was  disbelieved  she  wished  to  exhibit  a 
convincing  proof  of  the  ferocity  of  her  nature,  that  she  might 
instantly  be  conveyed  to  Newgate  and  hanged,  which  she  de- 
sired as  the  greatest  blessing.  With  considerable  satisfaction 
we  may  add  that  in  a  few  months,  notwithstanding  her  de- 
rangement had  been  of  three  years'  duration,  this  woman  per- 
fectly recovered,  and  for  a  considerable  time  performed  the 
duties  of  an  important  and  respectable  office." 

Homicide  Through  Insane  Inspiration. — The  instances 
when  the  individual  commits  a  crime  under  the  influence  of  an 
insane  inspiration  are  numerous.  Dr.  Gray  reports  the  case 
of  a  "  man,  aged  65,  married,  two  children,  farmer,  temperate  ; 
was  a  case  of  periodic  mania,  and  had  suffered  from  several 
previous  attacks.  Had  been  insane  a  month  prior  to  admission, 
was  talkative,  incoherent  and  exalted  in  his  delusions.  At- 
tempted to  kill  his  son  with  an  ax  and  a  pitchfork,  under  the 
delusion  that  he  had  received  a  divine  commission  to  perform 


4:  MEDICAL    JURISPRUDENCE. 

the  act.  Son  was  wounded  in  the  head,  He  continued  in  the 
Asylum  for  some  eight  years,  when  he  died  suddenly,  froii  heart 
disease." 

A  second  case  is  that  of  a  "man,  aged  31,  married,  two 
children,  cabinet  maker,  temperate.  After  becoming  insane  he 
talked  much  upon  the  subject  of  spiritualism,  developed  de- 
lusion that  he  was  the  medium  of  Jesus  Christ,  that  he  was 
filled  with  the  Holy  Ghost,  said  there  were  five  persons  in  the 
town  whom  he  was  authorized  to  kill  and  bury,  that  he  might 
afterward  raise  them  from  the  dead  and  make  them  better. 
A  few  nights  before  he  was  sent  to  the  Asylum,  after  retiring, 
got  up.  told  his  wife  he  was  going  to  get  a  hammer  with  which 
to  kill  her,  as  one  of  the  five  persons.  She  escaped  from  the 
window  to  a  neighboring  house,  whence  he  followed  her  in  a 
state  of  great  excitement,  but  was  secured  before  inflicting 
any  injury.  He  remained  in  the  Asylum,  some  eight  monllis 
in  a  maniacal  condition.  Was  noisy,  destructive  and  violent, 
and  in  this  state  broke  out  during  the  night  and  (Escaped." 

Distinction  Between  Acute  and  Clironic  Mania.— 

Acute  mania  is  distinguished  from  chronic  mania  by  the  in- 
coherence of  ideas,  by  the  excitement  and  violence.  In  the 
confirmed  disease  the  delirium  is  not  so  continuous. 

Circular  Insanity. — Folic  circnkdre  {or  folic  a  double 
form)  is  a  form  of  insanity  characterized  by  alternating  attacks 
of  mania  and  melancholia.  It  is  most  common  nmong  women, 
and  the  prognosis  is  bad.  It  is  to  be  recognized  in  the  success- 
ion of  attacks  separated  by  periods  of  comparative  freedom 
from  mental  disturbance.  The  melancholia  is  variable  in  in- 
tensity and  is  attended  by  great  debility  and  emaciation.  The 
yjatients  are  irresolute,  emotional  and  present  delusions.  The 
mania  is  apt  to  be  of  a  low  grade  and  it  may  simply  be  a  form 
of  excitenient  of  a  mild  kind.    (See  Appendix  C.) 

Delirium    as  distinguished  from   Mania.— The   de- 

liriu7n  of  fever  is  often  confounded  with  maniacal  excitement. 
Besides  the  history  of  the  particular  disease  we  find  that  the 
mental  excitement  of  delirium  is  disorderly  and  chaotic  in  the 
extreme.  There  is  a  rapid  succession  of  expression  in  which 
there  is  no  consecutive  character.  "  Memories  are  confounded 
with  perception,  and  are  often  more  real  than  sensory  im- 
pressions.' Reasoning  power  is  lost.  In  mania  tlie  reverse  is 
the  case  for  the  individual  reasons,  though  falsely  ;  and  there 
are  times  when  the  mental  disturbance  wanes  and  is  broken  by 


GENERAL    CONSIDERATION.  43 

interruptions  when  the  patient  is  more  cognizant  of  his  sur- 
roundhigs.  The  age  of  the  person  and  the  association  of 
physical  prostration  are  inseparable  from  delirium — we  find  no 
such  marked  functional  disturbance  in  mania — the  departure 
from  ordinary  bodily  health  being  comparatively  slight. 

Crimes  of  the  Puerperal  Insane. — A  form  of  mania 
follows  delivery  in  from  a  few  days  to  a  month  or  more,  and 
occurs  most  frequently  before  the  lochia  are  stopped.  It  is 
usually  attended  with  the  appearance  of  albumen  in  the  urine, 
with  interruption  or  suppression  of  the  secretion  of  milk,  or 
the  subsequent  stoppage  of  the  lochial  discharge.  The  patient 
may  either  in  the  beginning  be  melancholiac  or,  on  the  other 
hand,  loquacious,  laughing,  and  foul  in  her  talk.  She  then  has 
delusions  of  a  religious  character,  or  believes  she  is  persecuted  ; 
and  there  is  incoherence  perhaps  if  the  excitement  be  sufficiently 
acute.  She  seems  to  have  a  loss  of  memory  of  recent  events, 
may  or  may  not  correctly  recognize  persons  about  her,  but 
most  frequently  does,  and  she  seems  to  pay  very  little  attention 
and  evidently  does  not  care  much  for  her  baby.  During  a 
period  of  acute  delirium,  or  more  often  at  times  when  there  is 
an  apparent  lull  in  her  mental  condition  and  when  it  is  sup- 
posed that  she  is  getting  better,  she  may,  when  carelessly  left 
to  herself,  strangle  or  make  away  with  her  offspring.  Puerperal 
mania  is  often  of  such  a  masked  character  that  the  homicidal 
acts  are  simply  incredible,  and  in  many  instances  there  is  acute 
realization  upon  the  part  of  the  patient  of  the  nature  of  the 
crime  and  its  consequences,  but  we  will  be  convinced  of  the 
irresponsibility  of  such  a  person  by  the  iTiotiveless  method  of 
execution  and  the  open  way  in  which  it  is  perpetrated. 

Women  suffering  from  puerperal  mania  are  very  apt  to  com- 
mit the  most  unexpected  crimes.  Sometimes  the  acts  of  vio- 
lence are  entirely  misunderstood  by  juries,  and  despite  com- 
petent medical  testimony  the  patients  are  simply  supposed 
to  destroy  their  children  with  the  idea  of  ridding  them- 
selves of  incumbrances  ;  fortunately,  however,  the  crimes 
are  so  brutally  executed,  and  often  more  than  one  person 
is  murdered,  so  that  no  doubt  can  be  raised  as  to  the 
real  condition  of  the  patient.  Such  a  case  is  related  by 
Winslow.  "  A  woman  was  delivered  of  a  child  on  the  tenth  of 
December,  1848.  At  the  expiration  of  a  week  she  was  seized 
with  a  violent  attack  of  puerperal  mania.  Mr.  Bell \of  Til- 
stead,  her  medical  attendant,  gave  instructions  that  she  should 
be  carefully  watched,  and    on  no  account  have  access  to  her 


44  JNIEUICAL    JURISPRUDENCE. 

child.  On  the  twenty-third  of  December,  in  the  absence  of 
her  attendant  she  persuaded  her  daughter  to  bring  the  infant 
to  her,  and  obtaining  possession  of  a  razor,  she  ahnost  im- 
mediately cut  the  child's  throat.  The  prisoner  appeared  quite 
calm  and  collected  after  the  occurrence  and  admitted  that  she  had 
destroyed  the  child,  and  that  the  crime  was  premeditated."  This 
case  is  but  one  of  a  large  number.  Crimes  committed  by  the 
puerperal  woman  are  very  often  impulsive  and  maybe  preceded 
by  a  state  of  torturing  doubt,  which  the  patient  generally  con- 
ceals ;  and  we  find  in  many  women  who  perhaps  do  not  go  so 
far  as  murder,  a  history  of  morbid  impulses  which  they  have 
resisted  for  a  long  time.  One  of  my  patients  felt  a  strong  de- 
sire to  kill  her  child  when  it  was  placed  in  bed  by  her  side, 
and  insisted  that  it  should  be  taken  out  of  the  house  during  her 
convalescence.  Most  authors  insist  that  the  presence  of  the 
object  is  a  strong  incentive  to  the  stimulation  of  the  homicidal 
instinct.  We  find  that  certain  individuals  are  incited  to  suicide 
by  drowning  when  they  hear  the  rushing  of  water,  as  was  the 
case  in  an  example  reported  by  Burroughs,  and  this  same 
theory  applies  to  puerperal  insanity,  in  fact,  to  many  of  the 
other  impulsive  forms  of  mental  derangement.  A  woman  aged 
about  thirty-five  who  consulted  Falret,  declared  that  she  had 
sudden  temptations  when  nursing  her  infant,  to  dash  it  to  the 
ground,  trample  on  it  and  destroy  it.  She  was  also  prompted  to 
destroy  herself  in  different  ways.  When  passing  through  a  hall- 
way she  was  prompted  to  dash  her  head  against  the  wall,  or  if 
she  saw  a  knife  on  the  table  when  carrying  the  child,  it  was  as 
much  as  she  could  do  to  restrain  herself  from  seizing  the 
instrument  and  cutting  its  throat. 

General  Paresis  of  the  Insane. — General  Paresis  of  the 

Insane  is  a  disease  in  which  conspicuous  mental  and  physical 
symptoms  are  presented.  Beginning  with  slight  alterations  in 
manner,  which  are  often  disregarded  or  mistaken,  and  by  very 
subtle  physical  changes,  the  affection  very  rapidly  advances,  so 
that  before  many  months  there  can  be  no  doubt  about  the  na- 
ture of  the  affection.  The  disease  nearly  always  follows  dissi- 
pation, remote  syphilis  or  high  living,  and  as  a  cause  alcoholism 
or  syphilis  play  important  parts — though  undoubtedly  in  many 
patients  no  such  causes  exist-  and  mental  overwork  is  sufficient 
to  account  for  its  genesis  In  America,  especially,  we  find 
that  the  unreasonable  haste  to  accumulate  riches  and  the 
overvaulting  ambition  to  keep  abreast  with  the  more  suc- 
cessful,  liave    had    much    to   do    with    the   development    not 


GENERAL    CONSIDERATION.  45 

only  of  nervous   diseases   in  general,  but  general   paresis  in 
particular. 

Delusions  of  (xrcindeur. — The  earliest  mental  change, 
after  carelessness  in  appearance  and  habits,  is  a  boastful  vanity, 
— which  renders  the  individual  ridiculous — mere  lying  is  followed 
by  the  wildest  Munchausen  braggadocio.  He  will  perhaps  tell 
you  that  he  has  horses  which  are  faster  than  any  in  the  world. 
That  his  diamonds  exceed  in  value  the  crown-jewels,  or  that  he 
has  crossed  the  Atlantic  several  hundred  times  when  he  has  per- 
haps been  only  two  or  three.  Later  on  he  grows  more  expansive. 
No  scheme  is  too  great  for  him.  One  man  told  me  that  he  had 
hired  Patti,  Nillson,  and  all  the  great  prima  donnas,  and  had  built 
an  opera  house  ten  miles  long  ;  another  that  he  could  speak  all 
the  known  languages  including  Arabic,  Sanskrit,  and  the  He- 
brew although  he  was  a  printer  with  scarcely  any  education  to 
speak  of.  Many  paretics  believe  themselves  possessed  of  extra- 
ordinary physical  force  and  avow  their  power  to  lift  the  heaviest 
weights  and  perform  the  most  extraordinary  feats.  The  grand 
delusions  of  some  take  the  form  of  sexual  capacity,  and  it  is 
not  rare  to  find  them  boasting  of  powers  that  excelled 
those  belonging  to  any  of  the  personages  of  the  Old  Tes- 
tament who  possessed  innumerable  concubines.  With  this  there 
is  foolish  extravagance,  and  the  purchase  of  useless  things. 
One  man  will  contract  for  property  for  which  he  cannot  pay, 
or  buy  numberless  pictures  for  which  he  has  no  use.  He  will 
order  large  quantities  of  jewelry  or  precious  stones.  He  re- 
sents interference  and  the  counsel  of  friends  with  violence,  and 
plunges  into  the  wildest  excesses.  He  debauches  himself  and 
consorts  with  prostitutes,  and  no  form  of  bestiality  satisfies  his 
desires  At  this  time  it  will  be  noticed  perhaps  that  his  pupils 
are  unequally  dilated,  one  being  larger  than  the  other  (usually 
the  right) — or  that  they  are  contracted  to  the  size  of  pin-heads. 
His  tongue  when  protruded  trembles  slightly,  th-e  tremor  being 
fine,  and  accompanied  with  sudden  retraction  of  the  whole 
organ  when  the  effort  is  continued  to  keep  it  protruded.  As 
the  disease  advances  the  lips  in  turn  become  tremulous,  and 
the  corners  of  the  mouth  uneven.  The  speech  is  clumsy,  and 
there  is  great  difficulty  in  pronouncing  the  labials  and  lin- 
gual consonants.  The  mental  state  keeps  pace,  and  the  delu- 
sions are  more  marked — they  are  however  occasion:^ny  con- 
cealed, but  this  is  rare.  It  is  common  to  find  fits  of  violence 
from  time  to  time,  and  in  these  the  patient  may  be  actually 
dangerous.     In  some  cases,  and  by  no  means  a  small  number, 


.  ^f)  MEDICAL    JURISPRUDENCE 

there  is  an  initial  stage  of  melancholia,  and  I  am  convinced 
that  this  is  more  marked  in  cases  of  general  paresis  following 
alcoholism.  Epileptic  attacks,  or  attacks  of  hemiplegia  often 
occur  during  the  course  of  the  disease,  but  these  latter  are 
indications  probably  of  some  organic  disease  which  occasionally 
accompanies  the  disease. 

Periods  of  Remission. — A  feature  of  general  paresis  are 
the  periods  of  remission,  which  may  last  several  weeks,  during 
which  the  patient  is  apparently  sane,  but  they  never  continue 
for  any  great  length  of  time,  and  the  mental  and  physical 
symptoms  reappear  with  great  violence.  As  the  malady  be- 
comes established  there  are  changes  in  the  gait,  which  is  titu- 
bating and  unsteady.  The  patient's  ocular  condition  may  vary, 
the  pupils  for  a  time  becoming  equal,  and  afterwards  unequal 
again.  The  temperature  is  elevated  during  the  disease,  more 
particularly  throughout  the  late  stages,  and  generally  after 
periods  of  excitement  or  convulsions. 

Dementia  is  the  ending  of  general  paresis,  and  an  enfeeble- 
ment  of  all  the  mental  powers  takes  place.  The  disease  is  re- 
markably rapid  in  its  downward  progress.  It  commonly  ends 
fatally  in  three  years,  yet  there  are  cases  where  it  has  lasted 
eight  or  ten  years,  but  these  are  by  no  means  common.  The 
French  authors  are  disposed  to  consider  the  average  duration  of 
the  disease  to  be  less  than  two  years,  and  some  English  writers 
fix  it  at  twenty-two  months.  '1  he  duration  of  the  remissions  is 
extremely  variable.  Baillarger  has  reported  19  cases  in  which 
the  period  of  the  remission  varied  from  one  month  to  two 
years.  Le  Grand  du  Saulle  has  presented  6  cases  in  which  it 
varied  from  ten  months  to  two  years.  Dagonet  believes  that 
during  the  remission  there  is  a  state  of  mental  feebleness  which 
is  incompatible  with  perfect  responsibility. 

The  early  stages  of  general  paresis  are  sometimes  likely  to  be 
the  subject  of  legal  inquiry.  In  the  beginning  of  the  disease 
the  individual's  extravagant  plans  are  apt  to  be  looked  upon  by 
laymen  as  simply  evidences  of  great  business  tact  and  energy, 
and  sympathetic  juries  do  not  take  the  trouble  to  ascertain 
whether  the  expenditures  are  in  keeping  with  the  means  of  the 
individual.  So,  too,  during  the  lucid  intervals  of  the  disease, 
legal  steps  may  be  taken  which  are  not  warranted  by  the  his- 
tory of  the  disease. 

Disputed  Cases  of  Paresis. — In  many  cases,  and  that  of 
Henry  Prouse  Cooper  was  an  e.\am])le,  'he  question  of  alco- 
holism arises.     In  this  case,  it  was   urged  that  his  peculiar  be- 


Ol!-NEliAL    CONSIDERATION',  47 

havior  was  simply  the  result  of  the  immoderate  use  ot  alcohol, 
and  it  was  attempted  to  show  ihat  some  of  his  physical  ex- 
pressions were  those  of  alcoholism.  Nothing  of  the  kind  was 
made  out,  and  when  we  come  to  carefully  compare  the  two 
diseases,  especially  in  regard  to  their  stages,  it  is  easy  to  make 
a  diagnosis.  The  testamentary  capacity  of  a  person  suffering 
from  general  paralysis  should  always  be  doubted,  especially 
when  the  question  of  extraordinary  or  unjust  bequests  are  made 
under  the  influence  of  the  extravagant  delusion. 

His  early  extravagance  may  lead  to  civil  suits,  and  unsus- 
pecting tradesmen  are  astonished  to  find  that  their  liberal  cus- 
tomer is  after  all  a  lunatic.  So  too  may  his  destructive 
propensities  get  him  into  trouble.  The  interference  of  any  one 
who  presumes  to  dispute  the  paretic's  right  to  do  just  as  he 
chooses,  is  very  likely  to  be  assaulttrd,  but  crimes  of  this  kind 
during  the  early  stages  of  the  disease  are  nut  common.  In 
certain  irregular  cases,  however,  the  subject  may,  under  delu- 
sions, indulge  in  homicidal  tendencies.  The  two  following  are 
examples,  and  both  patients  were  confined  in  the  Utica 
Asylum  : 

"  Man,  aged  56,  married,  five  children,  laborer.  He  had 
borne  the  reputation  of  being  an  intemperate,  vicious  man, 
and  had  spent  the  season  in  the  County  House  ;  was  arrested, 
wandering  about  the  streets  in  a  drunken  condition,  and 
placed  in  jail.  Here  he  developed  delusions,  regarding 
the  chastity  of  his  wife,  became  maniacal  and  violent  in  threats 
and  actions,  and  fractured  the  skull  of  his  keeper  by  throwing 
a  heavy  padlock  at  him.  He  was  sent  to  the  County  Asylum 
as  an  insane  man,  where  he  was  violent  in  speech  and  action, 
and  made  homicidal  attacks  upon  his  keeper  ;  thence  he  was 
committed  to  the  Asylum  at  Utica.  After  admission  said  he 
tried  to  kill  the  keeper  because  he  was  violating  the  chastity 
of  his  wife,  in  an  adjoining  room.  He  soon  developed  delu- 
sions of  wealth  and  power,  presented  the  marked  physical 
characteristics  of  paresis,  gradually  failed,  and  died  in  about 
six  months." 

"Man,  aged  28,  married,  farmer,  temperate.  Patient  was  a 
soldier  in  the  late  war,  and  while  in  the  service,  suffered  from 
rheumatism  and  chronic  diarrhoea,  and  never  regained  former 
good  health.  He  read  and  studied  the  Bible  a  great  deal,  as 
the  embodiment  of  the  higher  law,  and  upon  this  study  based 
his  claim  to  being  an  educated  and  superior  lawyer.  For  three 
or  four  years  had  entertained  this  delusion,  and  during  this 
time  had  neglected  his  legitimate  work,  claiming  he  was  fully 


48  MEDICAL   JURISPRUDENCE. 

engaged  in  legal  business.  He  went  about  talking  to  people 
of  legal  matters  and  serving  papers  upon  various  persons,  of 
an  incoherent  and  peculiar  character,  much  to  their  annoy- 
ance. Was  recognized  by  people  generally  as  a  lunatic.  He 
attended  an  auction,  and  having  bid  off  some  articles,  gave 
his  note  for  them,  which  was  worthless.  The  patient  was 
about  to  take  possession  of  them,  but  being  opposed  by  the 
owner,  attacked,  choked,  and  upon  his  attempting  to  escape, 
fired  at  him  with  a  revolver.  For  this  he  was  arrested,  placed 
in  jail,  where  he  was  noisy  and  sleepless,  and  thence  brought 
to  the  Asylum,  on  a  criminal  order.  He  had  exalted  delusions 
of  his  own  power,  asserted  he  had  direct  communication  with 
God,  was  noisy  at  night,  talkative,  and  refused  medicine,  and 
at  times  food.  After  about  six  months  he  was  transferred  to 
the  Asylum  for  Insane  Criminals." 

Relations  of  Criminal  Acts  to  Sleep. — A  peculiar 
mental  condition  named  by  the  Germans  ScJilaftriinkcnheit,  or 
SLEEP  DRUNKENNESS,  leads  sometimes  to  the  commission  of  a 
variety  of  acts  for  which  the  individual  is  usually  clearly  irre- 
sponsible. In  the  hazy  mental  state  l)etween  sleeping  and 
waking,  there  may  be  a  veritable  condition  of  somnambulism. 
I  have  known  of  a  gentleman  who  sometimes  did  the  most  pur- 
poseless things  immediately  after  being  aroused.  He  was  a  man 
of  most  exemplary  habits  and  refinement,  and  yet  swore  like  a 
trooper  when  suddenly  awakened  upon  one  occasion  from  a 
sound  sleep  in  a  railroad  car,  when  asked  for  his  ticket.  He 
often  struck  his  wife  during  the  night  under  the  impression  that 
she  was  a  burglar  with  whom  he  was  having  a  struggle  for  life. 
Instances  of  homicidal  violence  are  reported,  and  not  only  may 
this  question  arise  as  a  legal  defense,  as  it  did  in  the  case 
mentioned  by  Bucknill  and  Tuke,  of  the  woman  who  threw 
her  child  out  of  the  window  ;  but  it  may  become  a  question 
for  divorce  proceedings,  or  theft. 

The  medico-legal  (|uestions  arising  in  connection  with  som- 
nambulism are  interesting,  and  it  cannot  be  denied  that  the 
somnambulist  is  irresponsible  for  actions  which  are  the  result 
of  unconscious  cerebration.  The  courts  all  hold  that  when 
he  does  not  preserve  the  rational  use  of  his  will,  and  is  deprived 
of  the  cognition  of  outward  surroundings,  he  cannot  be  con- 
victed. 

In  cases  of  homicide  committed  in  the  half  somnolent 
state,  it  is  well  to  ascertain  all  the  facts  in  the  case,  for  there 
raav  be  in  addition  to  the  somnambulistic  condition  an  element 


GENERAL    CONSIDERATION. 


49 


of  actual  insanity.     Dr.  Gray  reports  tlie  following  case,  which 
may  be  presented  in  illustration  : 

"  Male,  aged  29,  a  boatman,  of  intemperate  habits,  and  of 
insane  parentage  ;  had  been  in  a  melancholy  state  for  some 
months.  His  father  went  to  his  room  one  evening  to  ascertain 
whether  his  son  was  at  home.  Having  no  light,  he  repeated 
his  name  several  times.  Patient,  who  was  dozing  upon  his 
bed,  sprang  up,  thinking  his  father  was  shouting  for  help, 
seized  a  club,  and  encountering  him  in  the  dark,  killed  him  by 
a  single  blow.  Was  demented  when  admitted  to  Asylum. 
Discharged,  recovered." 

Somnaiiil)ulism  and  Epilepsy. — The  complication  of 
epilepsy  with  somnambulism  often  exists,  and  the  following 
interesting  case  of  murder  committed  by  a  young  man,  is  re- 
ported by  Dr.  Yellowlees  : 

"  James  Fraser  was  28  years  of  age,  married  and  had  one  child. 
He  was  pale,  dejected,  hair  black  and  always  rigidly  erect,  gen- 
eral health  and  habits  good,  and  he  was  in  regular  employment. 
As  a  child  he  was  rather  dull  and  stupid,  and  his  father  always 
thought  there  was  a  '  kind  of  want  about  him  ; '  as  a  man  his 
intellect  seemed  below  the  average,  but  not  so  much  so  as  to 
attract  attention,  nor  to  prevent  him  from  earning  a  livelihood. 
His  mother  and  maternal  grandfather  were  subject  to  '  fits,' 
and  died  in  this  condition  ;  these  were  doubtless  epileptic, 
from  the  description.  His  maternal  aunt  and  her  son  were 
inmates  of  an  asylum,  and  the  child  he  killed  had  had  convul- 
sions about  six  months  before  this. 

"  He  had  always  since  a  child  been  a  somnambulist,  and  in 
this  condition  had  often  had  delusions  that  he  was  attacked 
by  some  wild  beast,  or  that  the  walls  of  the  house  were  about 
to  fall  in  upon  him  ;  and  under  such  delusions  would  chase  the 
imaginary  beast  about  the  house,  hurling  chairs  and  tables  at 
it,  with  his  eyes  wide  open,  and  avoiding  any  article  of  furniture 
in  his  pursuit.  Sometimes  he  would  seize  his  companion  by  the 
throat,  thinking  he  was  struggling  with  the  beast,  and  afterwards 
was  quite  unconscious  of  having  assaulted  any  one.  It  was  in 
one  of  these  attacks  that  he  killed  his  child  ;  he  thought  he 
saw  a  wild  beast  fly  up  through  the  floor  and  pass  toward  the 
back  of  the  bed  where  the  child  lay  ;  he  grasped  at  the  beast, 
trying  to  catch  it ;  succeeded  in  seizing,  it,  and  springing  out 
of  bed,  dashed  it  on  the  floor  or  wall  to  destroy  it.  This 
awakened  his  wife,  who  got  out  of  bed  and  found  that  he  had 
killed    the  child,  its  skull  being   extensively  fractured.     He 

4 


(•6  MfipiCAL    JURISPRLfDKJVCb. 

then  came  to  himself,  and  evinced  the  greatest  remorse  and 
sorrow,  ran  for  a  doctor,  and  did  all  in  his  power  for  the  child. 

"  Fraser  was  tried  at  the  High  Court  of  Justiciary  in  Edin- 
burgh, on  July  15th,  1878.  On  being  asked  to  plead,  he  said  : 
*  I  am  guilty  in  my  sleep,  but  not  guilty  in  my  senses.' 

"  The  trial  then  proceeded,  and  a  special  defense  was  lodged 
that  at  the  time  of  the  alleged  crime  the  prisoner  was  asleep. 
Several  medical  men  were  called  who  agreed  in  testifying 
that  when  the  fatal  occurrence  took  place,  Fraser  was  under 
the  delusion  that  he  was  killing  a  wild  beast,  and  was  entirely 
unconscious  of  the  real  nature  of  the  act.  They  also  agreed 
in  thinking  that  all  somnambulists  are  not  insane,  and  that 
there  is  no  recognized  category  of  insanity  under  which  som- 
nambulism is  included. 

"  The  important  question  was  whether,  in  the  wild  paroxysms 
which  distinguished  this  extremely  aggravated  case,  Fraser  was 
or  was  not  technically  legally  insane,  for  had  he  been  so  found, 
his  committal  to  a  criminal  lunatic  asylum  would  have  been 
inevitable,  and  this  would  have  seemed  a  peculiarly  hard  fate 
for  a  man  who  is  sane  except  for  a  few  minutes  of  unconscious 
excitement  recurring  every  two  or  three  weeks.  And  on  this 
question  the  medical  gentlemen  differed.  Therefore  His 
Lordship  suggested  to  the  jury  the  following  verdict,  which 
was  at  once  and  unanimously  accepted  : 

"  '  That  the  jury  find  that  the  parent  killed  his  child  when  he 
was  unconscious  of  the  nature  of  the  act  which  he  committed 
by  reason  of  a  condition  arising  from  somnambulism  ;  and 
that  the  parent  was  not  responsible.' 

"  Two  days  later  Fraser  was  set  at  liberty,  an  undertaking 
having  been  given  by  himself  and  his  father  that  he  would  hence- 
forth sleep  in  a  separate  room,  apart  from  any  other  person." 

Many  writers  allude  to  the  case  of  a  man  whg  awoke  in 
the  night  and  saw  a  fearful  specter.  He  called  out  "  who  is 
that  ? "  and  receiving  no  answer  raised  his  hatchet  and 
struck  at  the  advancing  phantom.  It  was  found  that  he 
had  killed  his  wife.  A  case  related  in  the  British  and 
Foreign  Medico-Chirurgical  Review  and  referred  to  by  Hood, 
is  that  of  a  peddler  who  was  in  the  habit  of  going  about  the 
country  with  a  sword  stick.  While  asleep  by  the  side  of  the 
road  one  evening  he  was  roughly  shaken  by  some  practical 
jokers.  The  peddler  suddenly  awoke  and  seizing  his  cane 
plunged  it  into  the  body  of  the  nearest  man.  He  was  tried 
for  manslaughter  and  convicted,  notwithstanding  the  testimoi.y 
of  medical  witnesses   that  his   mental   condition    at   the    time 


General  consideration.  51 

was  one  of  irresponsibility.  It  was  adduced  that  the  act 
after  all  might  have  been  due  to  passion.  If  there  had  been 
no  provocation  such  an  explanation  ■  would  have  been  ab- 
surd, but  as  it  was  it  must  be  said  that  it  might  have  been  an 
element  in  the  case. 

Cases  of  suicide  in  the  half  somnolent  state  are  occasionally 
reported.  An  old  lady  awoke  in  the  middle  of  the  night,  went 
down  stairs  and  threw  herself  into  a  cistern  of  water,  where 
she  was  found  drowned.  It  was  held  that  the  suicide  was  the 
result  of  certain  mental  impressions  conjured  up  in  the  mind 
during  a  horrible  dream. 

Hereditary  Influence. — The  question  of  hereditary  in- 
fluence is  often  referred  to  in  courts  of  law  and  much  impor- 
tance is  attached  to  the  admissions  of  the  medical  witnesses.  It  is 
only  in  late  years  that  evidence  showing  the  existence  of  in- 
sanity of  the  ancestors  of  an  individual  has  been  admitted. 
The  case  of  the  Queen  vs.  Rose  Touchett  in  1844  was  the  first 
case  in  which  the  decision  of  Chitty  was  reversed.  Hereditary 
tendencies  are  so  important  that  in  every  case  they  should  be 
shown  to  exist  if  possible,  but  some  caution  is  necessary.  Vague 
history  of  mental  disorder,  such  as  eccentricity,  is  almost  value- 
less when  it  exists  alone  ;  but  when  it  can  be  shown  that  the 
])arents  of  the  alleged  lunatic  have  been  deranged  the  matter  is 
different.  According  to  the  experience  the  tendency  to  mental 
disease  is  greater  when  insanity  has  existed  in  lineal  ancestors. 
The  insanity  of  aunts  arid  uncles  or  cousins  has  no  such  impor- 
tance as  the  insanity  of  the  grandfather  or  grandmother,  the 
mother  or  father,  or  the  sister  or  brother.  So,  too,  we  should 
take  into  consideration  th;'  date  of  the  remote  insanity,  for  that 
occurring  after  the  birth  of  the  child  does  not  necessarily  show 
that  there  is  any  reason  to  suppose  it  to  be  the  subject  of  any 
Inherited  tendency.  An  exception  may  be  made,  however, 
in  those  forms  of  insanity  which  crop  out  late  in  life 
m  persons  in  whom  the  inr^ane  predisposition  exists.  Bail- 
larger's  conclusions,  referred  to  by  Bucknill  and  Tuke,* 
show  that  the  insanity  of  the  mother  is  far  more  serious 
than  that  of  the  father  as  regards  transmission,  and  so, 
too,  the  transmission  from  the  mother  is  more  apt  to 
be  shown  in  girls  than  boys,  while  the  reverse  is  true  regard- 
ing the  insanity  of  boys.  Of  course  the  existence  of  insanity 
in  several  members  of  the  same  family  is  serious.  In  epileptic 
insanity  it  may  be  found  that  the  mother  of  the  patient  has 

*  Mnmial  of  Psyclioloijical  Medicine,  p.  63. 


ga  MEDICAL    JURISPRUDENCE. 

suffered  from  migraine  or  some  other  form  of  nervous  disease, 
and  it  will  often  be  found  that  the  existence  of  phthisis,  as 
shown  by  Anstie  and  others,  is  very  apt  to  predispose  to  the 
development  of  epilepsy  in  the  following  generation.  It  is  a 
common  thing  to  find  organic  nervous  diseases  occurring  in  the 
parent  after  the  birth  of  the  alleged  lunatic,  brought  for- 
ward as  an  hereditary  factor  when  it  often  has  no  connection 
whatever  with  the  possible  mental  disease.  In  the  matter  of 
prognosis  hereditary  tendency  is  a  very  dangerous  factor.  The 
prognosis  of  insanity  is  fairly  good  in  acute  forms — mania 
better  than  melancholia,  but  with  dementia,  general  paresis  or  in- 
sanity, dependent  upon  organic  diseases  of  the  brain  the  case  is 
different.  Recovery  sometimes  follows,  even  after  insanity  last- 
ing a  number  of  years,  but  this  is  rarely  so  ;  or  an  acute  disease 
may  break  up  the  condition  and  turn  its  course.  Prognosis  is 
better  in  young  subjects  than  old.  Epilepsy  in  complication 
is  a  bad  feature.  Insanity,  coming  after  the  change  of  life,  is 
very  apt  to  run  into  dementia. 

Post  Mortem  Examination  of  the  Insane. — In  cases  of 
suspected  insanity  where  during  lifetime  its  existence  has  been 
doubted,  the  matter  is  often  settled  by  an  examination  after 
death.  As  I  have  already  said  we  cannot  predict  that  distin- 
guished cerebral  disease  ahvays  exists  with  insanity,  that  is,  dis- 
ease which  gives  rise  to  the  insanity  ;  on  the  other  hand,  it  is 
not  uncommon  for  us  to  find  very  extensive  and  general  gross 
lesions  producing  no  appreciable  disturbance  of  intellect ;  so 
in  our  limited  state  of  knowledge  it  is  not  well  to  be  too 
positive. 

We  must  consider  in  all  cases  the  configuration  of  the  brain, 
its  size,  and  the  depth  of  the  gray  cortical  substance,  as  well  as 
the  signs  of  recent  disease.  If  a  small  brain  has  an  increased 
specific  gravity  which  is  disproportionate  with  its  size,  we  shall 
probably  find  the  existence  of  sclerosis  and  atrophy.  It  has 
been  found  that  the  weight  of  the  brain  undergoes  decided 
modifications  in  connection  with  insanity,  and  Dr.  Clapham  of 
the  West  Riding  asylum,  who  has  done  so  much  in  craniometry 
presents  an  interesting  table  which  includes  1200  cases  of  in- 
sanity. It  would  appear,  according  to  this,  that  the  weight  of 
the  brain  is  greater  in  the  insane,  between  the  ages  of  40  and  50 
in  women,  and  between  50  and  60  in  men,  than  at  any  other 
time  ;  that  in  the  male  the  brain  weighs  more  proportionately 
in  idiocy  than  it  does  in  the  female  ;  that  the  average  weight 
of  the  brain  is  greater  in  mania  than  melancholia,  and  in  other 


Encephalon, 

Cerebellum, 

(Grammes.) 

Pons  and  Medulla. 

.       Age. 

1148.947 

I5f'-7 

21.94 

1285.009 

174-6 

36.2 

1310.956 

169.7 

49-132 

1278.382 

163  8 

64-843 

1291.949 

170.5 

53-810 

•,   1350-425 

172.8 

42.0S2 

1270.271 

174-0 

41.610 

1314-410 

164.4 

36.646 

1327.267 

171-q 

46.S63 

1256.644 

164-3 

60.929 

GENERAL    CONSIDERATION.  53 

forms  of  acute  insanity  than  in  senile  or  organic  dementia,  im- 
becility or  general  paresis. 

Disease. 
Idiocy, 
Imbecility, 
Dementia  (simple), 

Senile, 

Organic, 
Mania,  Melancholia  and  acute  forms,  i 
General  Paralysis, 
Epileptic  Insanity, 
Chronic  Mania, 
Brain  Wasting, 

It  is  a  popular  but  erroneous  impression  that  the  largest 
brains  belong  to  the  possessors  of  the  greatest  intellect.  This 
is  far  from  the  truth,  for  one  of  the  largest  upon  record  belonged 
to  an  idiot.  The  left  frontal  lobe  is,  according  to  Broca, 
heavier  than  the  right,  and  Luys  has  found  a  difference  in  favor 
of  the  former  of  from  five  to  eiglit  grammes. 

The  depth  of  the  gray  matter  of  the  convolutions  we  are  en- 
abled to  detect  by  means  of  an  instrument  invented  by  Dr. 
Herbert  Major.  This  consists  of  a  glass  tube  finely  graduated, 
by  which  we  may  remove  portions  of  the  cortex  of  the  brain  by 
thrusting  the  gauge  into  the  particular  convolution,  the  depth 
of  which  we  wish  to  determine,  and  removing  a  plug  of  white 
and  gray  matter.  It  will  be  found  in  certain  forms  of  insanity 
that  the  depth  of  the  gray  matter  has  undergone  material  dimi- 
nution ;  and  in  certain  cases,  notably  those  where  congenital 
deficiency  is  suspected,  we  shall  find  that  the  proportion  of  the 
white  and  gray  substances  is  very  much  changed,  the  latter 
being  reduced.  In  measuring  the  depth  of  the  gray  substance 
of  the  convolutions  it  will  be  found  that  it  is  reduced  from 
eight  one-hundreths  of  an  inch  to  six  or  seven  one-hundredth s. 
Bucknill  and  Tuke  prefer  measurements  made  with  a  hair 
divider,  a  variety  of  small  compass,  to  the  instrument  invented 
by  Herbert   Major. 

Benedikt  and  other  German  writers  place  great  reliance 
upon  peculiarities  in  the  arrangements  of  the  convolutions 
and  sulci  in  the  brains  of  insane  criminals.  While  I  do 
not  believe  that  Benedikt's  ideas  are  always  susceptible  of 
proof,  it  is  still  a  noteworthy  fact  that  in  the  brain  of  the  con- 
genital criminal  there  is  great  complexity  and  irregularity  in 
the  arrangement  of  the  convolutional  folds,  and  fissures.  In 
his  book  upon  the  subject  he  presents  a  number  of  autopsies 


54 


MEDICAL    JURISPRUDENCE. 


Fi?.  I. 

(Benedikt>. 

External  fissural  arrangement  of  a  typical  brain. 

(For  reference  see  American  traiiblation.) 


^tfH^ 


Fir.  2. 

(Benedikt), 

External  fissural  arrangement  of  an  atypical  brain. 


GENERAL    CONSIDERATION.  55 

the  subjects  of  which  were  criminals,  and  in  every  instance 
there  were  certain  peculiarities  which  he  has  minutely  detailed, 
and  these  consisted  not  only  in  the  excessive  fissure  develop- 
ment, but  in  the  repeated  existence  of  asymmetries  of  the  brain 
and  the  skull  itself.  The  parietal  lobe  was  usually  dwarfed,  the 
cerebellum  was  only  partially  covered  by  the  occipital  lobe,  and 
there  was  a  deficiency  in  Wernicke's  fissure  ;  the  inter-parietal 
fissure  communicated  very  frequently  with  the  fissures  of 
Sylvius,  and  the  parieto-occipital  with  the  horizontal  and  inter- 
parietal. 

We  are  also  to  look  for  asymmetry  of  the  two  hemispheres, 
and  for  convolutional  errors  of  development. 

The  brain  in  imbeciles  and  idiots  presents  malformations  and 
arrestment  of  development  which  are  very  characteristic.  These 
modifications  take  the  form  of  atrophies  of  parts  of,  or  groups  of, 
convolutions  of  the  cortex  ;  and  the  partial  atrophies  are  re- 
vealed by  a  thinning  of  the  folds,  and  by  a  corresponding  en- 
largement and  depth  of  certain  fissures.  These  are  principally 
in  the  frontal  convolutions,  which  present  irregularities  of  for- 
mation. Asymmetry  is  very  noticeable  in  the  brains  of  idiots, 
the  two  lobes  presenting  very  often  a  want  of  correspondence 
which  is  very  decided.  From  a  histological  point  of  view  we 
find  arrestee^  development  depending  upon  defects  in  the  ap- 
paratus of  nourishment  in  the  cortical  substance. 

Luys*  has  devoted  much  attention  to  the  subject  of  the  con- 
volutional anatomy  of  the  brain  in  the  insane,  who  finds 
that  the  fissure  of  Sylvius  is  usually  enlarged,  and  extends 
much  further  back  than  it  does  in  the  normal  brain,  ex- 
posing the  insula.  The  fissure  of  Rolando  is  very  nearly 
normal,  but  its  continuity  is  interrupted  by  irregularities  which 
jut  out  from  the  marginal  convolutions. 

Luys  has  collected  pathological  data  of  great  interest 
which  show  that  certain  definite  convolutional  changes  are  to 
be  found  in  many  cases  of  insanity.  The  most  frequent, 
according  to  him,  are  seen  in  the.  frontal  convolutions  which  are 
much  more  irregularly  disposed  in  the  right  than  in  the  left  lobe. 
The  first  frontal,  especially,  is  very  frequently  atrophied  and 
diminished  in  breadth.  Luys  has  found  in  a  case  with  well 
marked  hallucinations  that  in  the  internal  aspect  of  the  cere- 
bral hemisphere  the  paracental  lobule  jutted  out,  and  the  first 
frontal  was  depressed,  and  the  second  frontal  had  undergone 
at  its  anterior  part  decided  irregularities.  Here  its  continuity  was 

*TraiLe  cliniqiie  et  Pra'ique  des  Maladies.Mwtal.es,  1.88;., 


5t> 


MJi^iJlCAi.    JURISPRUDENCE. 


broken  up  by  a  series  of  secondary  multiple  folds  having  a  ver- 
miform appearance  and  bridges  over  the  superior  frontal  fissure 
which  was  obliterated.  In  certain  cases  of  chronic  dementia  the 
second  frontal  convolution  becomes  almost  rudimentary.  The 
third  frontal  convolution  (the  speech  center)  is  rarely  modified 
except  when  there  is  ai)hasia.  Luys  has  found  in  three  deaf 
mutes  that  it  was  atrophied  upon  the  left  side. 

The  ascending  frontal  convolution  often  presents  change  in 
its  length  and  continuity.  At  its  union  with  the  second  frontal 
we  find  numerous  variations,  and  Luys  has  seen  a  change  at 
the  origin  of  the  third  frontal.  The  ascending  parietal  is  quite 
rarely  affected  except  in  cases  with  paralytic  symptoms.  I  saw 
a  case,  the  drawing  of  whose  brain  I  present,  who  had  in  addi- 
tion to  chronic  mania  and  dementia  well  marked  paralysis  and 
contracture  upon  the  opposite  side  of  the  body  ;  the  insanity 
began  shortly  before  the  paralysis  and  the  secondary  dementia 
appeared  very  rapidly.     Luys  is  of  the  opinion  that  the  ascend- 


Fig.  3. 
A.  Atrophy  of  ascending  frontal  and  parietal  convolutions. 

ing  frontal  and  parietal  convolutions  least  often  present  patho- 
logical changes.  The  angular  gyrus  is  sometimes  affecterl,  ard 
in  cases  with  visual  halhicinatiuns  it  probably  is  fn'qncntlv. 


GENERAL    CONSIDERATION.  57 

The  internal  surface  of  the  brain  shows  that  the  paracentral 
lobule  is  often  the  seat  of  pathological  changes,  on  one 
side  or  both,  and  it  is  the  opinion  of  Luys  and  other  writers, 
that  in  advanced  cases  of  dementia  botli  lobules  will  be  affected. 

In  the  insane  it  will  be  found,  especially  in  forms  of  chronic 
mania,  or  where  there  has  been  excitement,  that  the  meninges 
are  thickened,  hyperemic,  or  that  there  are  collections  of  blood 
known  as  hematoma.  The  dura  mater  is  often  adherent  to  the 
skull,  and  the  other  membranes  show  evidences  of  various 
grades  of  inflammation,  and  it  is  difificult  to  remove  the  arach- 
noid and  pia  mater  without  tearing  away  more  or  less  of  the 
brain  substance.  There  may  be  found  lesions  of  the  blood- 
vessels, which  vary  from  simple  congestion  to  atheromatous  de- 
generation or  permanent  dilatation,  and  this  is  found  either  in 
the  substance  of  the  meninges  or  in  the  brain  itself. 

The  vascular  condition  is  either  one  connected  with  hyper- 
emia or  anemia.  Evidences  of  hyperemia  are  common  in 
disease  attended  with  excitement  such  as  mania  or  paresis.  The 
gray  substance  is  darker  and  the  white  is  more  pink  or  yellow 
than  in  health.  Minute  piinctce  vasculosa,  extravasations  or 
local  tracts  of  active  congestion  are  found.  In  general  paresis 
Luys  has  found  these  spots  of  hyperemia  more  marked  in  the 
frontal  region,  though  in  this  disease  it  is  common  to  find  the 
congestion  very  general.  In  melancholia  we  meet  with  a  pale 
condition  of  the  tissues,  with  diminished  vessels  and  perivascular 
accumulation  of  fluid.  The  brain  is  blanched  and  soft.  Terri- 
tories of  edematous  brain  are  found  in  association  with  the 
plugging  up  of  small  vessels  by  an  embolus,  or  as  the  result  of 
thrombosis.     Evidences  of  cerebral  ischemia  are  important. 

There  may  be  bony  plates  in  the  dura  mater  which  are  very 
common  in  chronic  insanity,  or  adventitious  substances  scatter- 
ed over  the  surface  of  the  brain,  both  at  the  convexity  and  the 
base. 

The  brain  itself  presents  certain  changes  in  the  appearance 
of  its  convolutions  and  deeper  parts  which  are  quite  conspicu- 
ous. We  may  find  softening  and  sclerosis  giving  rise  to  atrophy 
and  depression,  and  changes  of  color  which  are  always  import- 
ant and  suggestive. 

Solly,  who  first  made  extended  examinations  of  the  cortex  in 
insane  patients,  found  a  paleness  of  that  portion  of  the  brain, 
particularly  in  cases  of  imbecility,  and  the  white  matter  of  the 
brain  assumed  a  "  dirty  brjwnish  hue,"  very  faint  but  quite 
distinct. 

The  lining  membrane  of  the  ventricles  is  often  thickened,  and 


^8  MEDICAL    JURISPRUDENCE. 

the  seat  of  a  granular  change,  and  an  accumulation  ^+  serous 
fluid  not  only  in  these  cavities  but  in  the  meshes  of  the  arach- 
noid, both  at  the  upper  surface  and  at  the  base  of  the  brain 
is  present.  The  substance  of  the  brain  may  be  the  seat  of  a 
diffused  change,  there  being  small  collections  of  indurated  tis- 
sue which  are  so  frequently  present  in  general  paresis.  In  insanity 
produced  by  alcohol  this  appearance  is  particularly  noticeable. 
In  other  cases  we  find  collections  of  gummatous  substance 
peculiar  to  syphilis.  In  still  others,  those  with  diseased  vessels, 
there  is  one  or  more  blood  clots  partially  organized,  and  per- 
haps some  softening. 

In  many  brains  we  shall  find  a  condition  known  as  the  etat 
cribld.)  which  consists  in  a  number  of  small  openings  giving  to  the 
brain  a  porous  appearance,  and  it  is  a  result  of  a  previous  hy- 
peremia from  probable  exudation  of  serum  and  atrophy.  It 
is  rare  to  find  increase  in  size  of  the  brain  as  an  indication  of 
chronic  insanity.     Atrophy  is  much  more  common. 

Attention  may  be  called  to  the  thickening  of  the  cranial  bones 
in  chronic  insanity  and  the  existence  of  bony  spiculae  which 
is  sometimes  met.  Greding  presents  216  autopsies  ;  167  of 
these  presented  thickening,  and  38  more  or  less  thinness  of  the 
bones. 

-  In  melancholia,  Luys  has  found  in  several  cases  great  hyper- 
emia of  the  gray  substance  of  the  third  ventricle.  The  left 
optic  thalamus  presented  on  its  internal  face  hyperemic  red- 
ness, which  was  also  found  in  the  third  ventricle.  The  gray 
substance  of  the  cortex  of  one  of  these  patients  was  thin,  and 
most  of  the  convolutions  appeared  of  a  pale  color,  with  irregu- 
lar vascular  arborizations  irregularly  disseminated.  It  seems 
to  be  a  peculiarity  of  this  form  of  disease  that  there  is  a  gen- 
eral ischemia  with  localized  spots  of  hyperemia. 

In  some  cases  of  profound  iiiclancJiolia  ivii^i  stupor^  the  brain 
was  found  to  be  completely  exsanguinated,  the  white  substance 
deprived  of  vessels,  and  an  appearance  of  atrophy  of  the  cor- 
tex and  small  vascular  groups  was  presented  (de  petit  boquets 
vasculier  disposer  enilots). 

In  cases  of  general  paresis  excessive  and  abundant  proli- 
feration of  the  neuroglia  with  choking  of  the  nerve-cells  was 
apparent,  the  latter  being  diminished  in  number.  The  white 
substance  presented  the  same  aj^pearance  of  sclerosis,  the  nerve 
fibers  appeared  as  withered  filaments,  and  were  torn  and  much 
reduced  in  "size  ;  and  there  were  areolas  which  marked  the  dis- 
appearance of  nervous  elements. 

in  acute  mania,  Luys  found  evidence  of  active  and  violent 


GENERAL    CONSIDERATION.  ^g 

hyperemia  in  all  parts  of  the  brain,  but  the  vessels  of  the 
corpora  striata  were  most  dilated  and  engorged,  and  the  white 
substance  was  as  much  injected  as  the  gray.  In  one  of  his 
cases  there  was  yellow  coloration  of  the  insula,  with  degenera- 
tion of  all  the  nerve  elements  of  this  region.  In  another  an 
old  foyer  of  softening  occupying  the  center  of  the  protuberance 
was  found,  the  walls  of  which  were  encrusted  with  coloring 
matter,  granular  corpuscles  and  crystals  of  hematoidin,  which 
indicated  the  existence  of  prolonged  congestion,  and  which  for 
some  time  had  played  the  role  in  this  region  of  a  patholo- 
gical point  of  irritation. 

The  microscopic  appearances  of  diseased  nervous  tissue  are 
perhaps  of  greater  interest  than  any  others,  and  in  cases  where 
no  grave  lesions  are  presented  the  microscope  will  often  reveal 
delicate  changes  which  consist  most  commonly  in  degenera- 
tion of  the  nerve  cells  of  the  cortex,  and  vascuUir  hypere- 
mia and  its  consequences.  The  large  cells  of  the  cortical  gray 
substance  often  break  down,  and  leave  in  their  places  collec- 
tions of  granular  matter  which  may  be  either  found  in  isolated 
masses,  or  the  cell  wall  may  be  intact  and  its  contents  entirely 
disorganized,  there  being  disappearance  of  the  nuclear  elements. 
We  shall  also  find  that  the  inter-communicating  fibers  and 
nerve  cell  processes  are  broken  off,  and  that  the  inter-cellular 
connective  tissue  is  increased,  with  proliferation  of  the  neuro- 
glia cells,  and  perhaps  there  may  be  the  appearance  of  amyloid 
bodies.  The  bloodvessels  are  choked.  There  is  exudation  of 
coloring  matter  and  infiltration.  In  hyperemic  states  the 
vessels  are  dilated,  their  walls  are  covered  by  fat  granules  and 
hematoidin  crystals.  Sometimes  masses  of  pigment  are  found. 
The  vessels  are  varicose  or  disrupted,  and  the  peri-vascular 
spaces  may  be  filled  witn  exudation  corpuscles. 

The  nerve  cells  undergo  change  in  disease  which  are  so  de- 
cided as  to  have  attracted  the  attention  of  several  observers, 
Luys  among  the  number.  It  has  been  found  that  in  cases  of 
insanity  with  hallucination  they  are  greatly  increased  in  size, 
and  Meschede  has  found  that  in  general  paresis  the  increase  in 
size  of  the  central  cells  was  very  decided.  Luys  on  the  other 
hand  has  found  a  reduction  of  the  cells  in  general  paresis  as  well 
as  a  diminution  in  their  number.  In  some  brains  we  find  small 
vacuoles  scattered  through  the  brain  substance,  which,  however, 
are  more  often  the  result  of  careless  manipulation  (as  they  were 
in  the  <'Tuiteau  brain),  than  of  a  pathological  process. 

[n  this  connection  a  word  of  caution  is  necessary,  for  it  is  a 
very   easy   matter  through  improper  hardening  or  incautious 


OO  MEDICAL    JURISPRUDEN-CE. 

Staining  to  so  alter  the  arrangement  and  character  of  the 
anatomical  elements  as  to  produce  appearances  in  every  respect 
resembling  those  of  actual  disease.  Hardening  in  alcohol  is 
quite  likely,  unless  great  care  be  used,  to  have  this  result,  and 
sometimes  carmine  staining  with  a  badly  prepared  solution  will 
give  granular  changes  which  are  very  confusing.  In  hardening 
the  brain,  especially  where  medico-legal  questions  are  involved, 
Ave  must  frequently  change  the  fluid,  protect  it  from  dust,  and 
conduct  our  manipulations  in  a  systematic  and  careful  manner  ; 
and  it  is  well  to  have  our  observations  confirmed  by  another 
person. 

It  is  a  well  known  fact  that  heart  disease  is  very  common 
among  the  insane,  and  auto])sies  reveal  hypertrophy  and  val- 
vular obstruction  in  melanchoHa,  and  usually  some  dilatation 
where  the  mental  disease  has  taken  the  form  of  excitement.  In 
chronic  forms  of  insanity,  such  as  dementia,  we  find  fatty  de- 
generation in  connection  with  atheroma,  not  only  of  the  large 
vessels,  but  of  those  of  the  brain  as  well.  In  other  forms  of  dis- 
ease it  is  not  rare  to  discover  evidences  of  renal  or  hepatic 
degeneration  and  pulmonary  complications  leave  signs  of  their 
presence  during  life. 


CHAPTER  II. 


THE    LEGAL    RELATIONS    OF    INSANITY. 

We  now  come  to  the  consideration  of  the  special  questions 
that  may  arise  in  connection  with  the  legal  investigation  of  the 
acts  of  a  person  who  is  presumably  insane.  The  welfare  of  the 
individual,  and  of  society  at  large,  necessitates  the  most  careful 
and  patient  consideration  of  the  nature  of  the  behavior  and  re- 
sponsibility of  the  alleged  lunatic. 

Naturally  there  is  much  difference  of  opinion,  and  in  the  un- 
settled state  of  our  knowledge  of  mental  disease  grave  mistakes 
are  frequently  made.  The  medical  man  looks  more  humanely, 
perhaps,  upon  this  weakness  of  the  person,  and  considers  the 
mental  vagaries  as  the  result  of  disease — in  fact,  he  is  too  often 
inclined  to  build  up  an  impossible  standard  of  mental  integrity 
and  loses  sight  of  the  perversion  for  which  the  parents  or 
guardians  and  the  subject  himself  are  directly  responsible. 
The  jurist,  on  the  other  hand,  is  disposed  to  take  an  unneces- 
sarily hard  and  practical  view  of  the  situation,  and  is  apt  to  dis- 
regard the  facts  of  medical  science.  The  legal  tests  are  some- 
times too  arbitrary,  or  perhaps  too  loose,  and  are  not  ivarranted 
by  the  conclusions  of  carefully  made  psychiatric  data. 

Legal  Tests. — We  are  called  upon  to  testify  in  court  in 
civil  and  criminal  cases  under  the  following  circumstances  : 

1.  In  civil  cases  where  the  validity  of  a  will  or  contract  is 
questioned — where  the  nature  of  the  instrument  and  the  dis- 
position of  the  property  suggest  unsoundness  at  the  time  the 
instrument  was  made.  In  cases  where  the  ability  of  the  indivi- 
dual to  manage  his  affairs  and  take  care  of  himself  is  ques- 
tioned, and  to  appoint  for  him  a  guardian.  In  cases  where 
a  marriage  or  other  contract  has  been  made  by  an  insane 
person.     In  cases  of  divorce. 

2.  In  criminal  cases  where  the  acts  have  been  committed  by 
an  insane  and  irresponsible  person. 

Many  troublesome  points  arise,  even  though  the  facts  are 
often  clear,  and  our  task  is  usually  a  difficult  one.     Especially  is 


62  MEDICAL    JURISPRUDENCE. 

this  true  in  instances  where  the  departure  from  normal  mental 
health  is  slight,  or  where  the  insanity  is  shadowy  and  poorly 
defined.  In  individuals  of  weak  mind  the  delicate  question  of 
responsibility  should  be  patiently  sifted. 

The  Border  Land  of  Insanity. — There  are  a  large 
number  of  individuals  who  are  not  insane  in  the  legal  sense. 
These  persons  are  the  possessors  of  the  insane  temperament, 
and  in  mental  constitution  are  so  peculiar  as  to  to  attract  atten- 
tion of  those  with  whom  they  come  in  contact.  The 
shades  of  defect  are  of  the  most  varied  description.  Actual 
weakness  or  silliness,  or  harmless  eccentricity  may  exist, 
or  there  may  be  viciousness  and  criminal  tendencies  which 
may  render  the  person  dangerous  to  society.  In  such  cases 
there  may  be  a  considerable  degree  of  intellectual  vigor,  but 
the  mental  operations  are  directed  in  a  channel  which  degrades 
the  individual,  and  a  defect  of  moral  depravity  exists  which 
crops  out  upon  every  occasion.  The  criminal  class  is  largely 
composed  of  these  persons,  and  ordinarily,  hereditary  tendencies 
and  early  neglect  are  at  the  root  of  the  trouble.  To  such  a 
class  belonged  Guiteau  the  assassin,  who  showed  a  remarkable 
•vigor  of  mind  and  a  sickening  moral  nature.  Ruloff,  the  Bing- 
hamton  murderer,  was  another,  who,  though  his  intellectual  gifts 
as  a  philologist  were  something  extraordinary,  and  who  was  a 
laborious  student,  delighted  in  committing  innumerable  robber- 
ies and  petty  crimes,  but  ended  his  life  on  the  gallows  for  the 
murder  of  a  clerk  who  attempted  his  arrest.  Though  not  act- 
ually insane  in  the  legal  or  medical  sense,  both  of  these  men  are 
pitiable  examples  of  the  "  badly  arranged  mind,"  and  though 
presentmg  no  pathological  insanity,  were  of  eccentric  mental 
organization.  The  Germans  especially  have  devoted  much 
care  to  the  establishment  of  various  grades  of  weak-minded- 
ness, and  Krafft-Ebing  and  others  have  under  the  names 
pi'imdre  and  origindre  vcnicktheit  defined  these  kinds  of  moral 
depravity  of  congenital  origin.  I  regard  many  of  these  delicate 
distinctions  as  founded  upon  a  too  sentimental  plane,  for  if  we 
are  to  excuse  men  who  are  simply  had  for  the  crimes  they  may 
commit,  we  shall  open  the  doors  of  escape  for  all  manner  of 
wickedness. 

The  Guiteau  Case. — Guiteau,  as  I  have  said,  was  an  ex- 
ample of  the  class  of  neurotic  criminals  wliich  is  so  large,  and 
so  constantly  increasing,  and  in  his  case  had  there  been  prop&r 
environment,  he  might  have  become  at  least  a  harmless  member 
of  society,  if  not  a  useful  one.     I  may  be  pardoned  for  going 


THE    LEGAL    RELATIONS    OF    INSANI'J'Y.  63 

into  this  case  rather  extensively,  and  will  make  use  of  nott:.« 
previously  published.* 

Charles  Julius  Guiteau,  aged  forty  years,  is  of  spare  build,  of 
nervous  temperament,  weighs  one  hundred  and  thirty-five 
pounds,  and  is  five  feet  five  and  three  quarter  inches  in  height. 
He  is  badly  nourished  and  anemic. 

In  appearance  he  resembles  the  criminal  known  to  the  police 
as  the  "  sneak,"  and  his  physiognomy  is  one  more  familiar  to 
the  visitor  at  the  prison  than  the  asylum.  The  facial  lines  are 
deep,  and  express  the  constant  exhioition  of  the  baser  emotions. 
There  is  a  slight  furrow  between  the  brows  ;  the  nasal  lines  arc 
deep,  the  nose  thin  and  pointed  ;  and  the  lips  are  thin  and 
usually  slightly  parted.  His  hair  is  short  and  mixed  with  grav, 
and  so  cut  as  to  give  some  appearance  of  flatness  to  the  top  of 
his  head.  At  the  anterior  part  of  the  left  side  of  the  head  is  a 
slightly  depressed  scar  about  three  cm.  long,  the  lower  edge 
being  about  nine  cm.  above  the  center  of  the  external  auditory 
meatus,  and  the  superior  extremity  about  six  cm.  below  the 
longitudinal  median  line.  There  is  no  evidence  of  premature 
closure  of  the  sutures,  no-bregmatic  depression,  and  no  cranial 
exostoses.  The  conformation  of  the  head  is  no  way  atypical, 
neither  brachy-cephalic  or  dolicho-cephalic.  The  basal  circum- 
ference is  55.9  cm.  The  antero-posterior  arch  20.2  cm.  ;  the 
transverse  arch  16.5  cm.  ;  the  basal  antero-posterior  diameter 
19.5  cm.  f  A  conformateur  measurement  taken  at  a  higher 
level  posteriorly  at  the  plane  of  the  parietal  eminences  reveals 
no  special  asymmetry.  \ 

There  is  slight  fullness  on  the  right  side  both  anteriorly  and 

*  Boston  Medical  and  Surgical  yournal.  May,  9,  1882. 

\  It  has  been  stated  by  a  writer  in  the  New  York  Medical  Record  that 
my  measurements  were  made  at  so  low  a  level  as  to  prevent  me  from  recog- 
nizing the  existence  of  an  alleged  ridge  of  bone  passing  across  the  hack  of 
the  head.  The  writer  was  not  probaiily  aware  at  that  time  that  this  con- 
fo7mateur  measurement  was  taken  at  the  high  level,  but  nothing  was  shown. 
I  would  take  this  occasion  to  refer  to  the  trick  of  the  prisoner's  counsel,  who 
placed  the  conformateur  tracing  over  one  of  the  above — of  course  they  did 
not  agree. 

N.  B. — Subsequent  measurements  made  upon  the  naked  skull,  and  the 
tracings  made  by  Dr.  McConnell  of  the  Army  Medical  Museum  fully  sub- 
stantiate my  original  measurements. 

\  Clapham  (W.  R.  Reports,  vol.  vi.,  1876,  page  150),  gives  some  'ablesof 
skull  measurements.  He  found  that  a  man  weighing  130-140  pounds 
should  have  a  head  with  circumference  of  21.993  inches.  A  man  65  inches 
high  should  have  a  head  with  circumference  of  22.016  inches.  It  will  be 
Been  that  the  head  of  Guiteau  was  of  fair  size  according  to  Clapham's  figures. 


64  MEDICAL   JURISPRUDENCE. 

posteriorly.  I  did  not  calculate  the  facial  angle,  there  being 
nothing  to  attract  attention.  There  is  no  appearance  oi 
hematoma  auris  or  crenation  of  ears  so  often  found  in  the 
chronic  insane,  and  his  skin  sl.owed  no  abnormal  change, 
Deing  moist  and  not  scurfy.  The  fingers  were  devoid  of 
ungual  defects,  there  being  no  hangnails,  no  clubbing,  no 
temperature  nor  circulatory  changes.  The  teeth  are  regular, 
but  the  two  first  incisors  in  the  upper  jaw  are  separated  by  a 
slight  fissure  which  increased  the  malignity  of  the  prisoner's 
facial  expression  when  his  mouth  was  open.  The  back  teeth 
are  carious.  There  is  no  abnormality  in  the  roof  of  the  mouth, 
no  extreme  vaulting  of  the  palatine  process  of  the  superior  max- 
illary bone,  and  no  fissure. 

When  the  prisoner  was  told  to  open  his  mouth  he  did  so, 
and  the  opening  was  symmetrical,  there  being  no  defective 
muscular  antagonism.  Upon  my  first  visit  I  found  what  ap- 
peared to  be  a  fine  fibrillary  tremor  in  the  upper  cheek-muscles, 
and  eyelids,  but  this  was  after  an  exciting  day  in  court,  and  1 
never  saw  it  again.  The  unequal  tremor  of  the  tongue,  alluded 
to  by  Dr.  Folsom  in  his  able  paper,  was  not  observed  by  me 
except  upon  this  occasion,  and  it  was  not  manifested  except 
when  the  tongue  was  kept  protruded  for  some  time.  In  no 
respect  did  it  resemble  the  tremor  of  general  paresis,  and  it 
was  not  accompajiied  by  tremor  of  the  lips.  The  tongue  was 
protruded  slightly  to  the  left  side,  but  there  was  no  atrophy 
whatever,  and  it  cowld  be  freely  pointed  to  the  other  direction, 
and  its  tip  approximated  to  the  roof  of  the  mouth.  I  tested 
his  speech  carefully,  but  found  no  impairment,  but  in  court  he 
momentarily  hesitated  because  his  ideas  were  evolved  too 
rapidly,  and  the  function  of  the  cerebral  speech  centers  did 
not  seem  to  keep  pace.  A  careful  ophthalmoscopic  examina- 
tion failed  to  reveal  any  neuritis  or  atrophy,  and  Dr.  Loring 
was  equally  unsuccessful  in  making  any  discovery  of  oculrr 
trouble.  We  found  him  to  be  hypermetropic,  and  the  left  eye 
was  the  seat  of  conjunctivitis  at  the  first  visit,  and  quite  sensi- 
tive, and  as  a  result  the  pupil  was  slightly  contracted,  but  only 
upon  one  occasion  was  this  observed,  his  pupils  being  after- 
wards normal,  and  contracting  perfectly  to  diffused  and  artifi- 
cial light.  The  pupils  were  not  contracted  as  is  the  case  in 
the  early  stage  of  general  paresis. 

Tests  of  motility  were  negative.  He  walked  well  without 
any  drag,  and  there  was  no  disturbance  of  coordinating  power. 
I  tested  the  tendon  reflex  in  the  extremities  both  by  Buzzard's 
and  Gower's  method,  and  in  the  ordinary  way,  and  I  failed 


THE    LEGAL    RELATIONS    OF    INSANITY.  65 

after  repeated  examination  to  discover  any  abnormal  increase, 
and  light  and  heavy  blows  failed  to  evolve  2,  jerk  of  any  kind, 
but  there  was  moderate  responsive  action,  equal  on  both  sides. 
with  no  secondary  jerk.  Hand  grasp  unaffected,  and  he  could 
localize  small  objects.  Hearing  was  normal.  Retains  urine 
for  several  hours  even  when  excited,  and  when  passed  it  is 
neither  forcibly  ejected  nor  does  it  dribble.  He  says  he  has 
had  a  gonorrhoea,  and  his  stream  is  spiral,  so  he  probably  has 
some  stricture.  He  denies  absolutely  that  he  has  ever  had 
syphilis^  and  no  evidences  are  found.  He  has  a  small  herpetic 
patch  on  the  forehead,  but  this  is  probably  due  to  his  depraved 
physical  condition.  There  is  no  evidence  to  show  that  he  has 
indulged  in  bad  sexual  habits  in  jail.  Pulse  found  to  be  88 
upon  two  occasions.  Temperature  taken  daily  by  jail  physician 
shows  no  abnormal  rise. 

It  would  be  going  over  much  wearisome  ground  to  again 
attempt  to  analyze  the  evidence  introduced  in  court  except  to 
insist  upon  what  I  believe  to  be  the  truth,  that  he  is  an  eccen- 
tric criminal,  who  has  been  playing  a  part  in  court  that  might 
at  least  (if  not  humbug  the  experts)  affect  the  jury,  and  gain 
for  him  a  disagreement. 

None  of  the  expressions  of  disorderly  mental  action  upon 
the  part  of  the  prisoner,  either  isolated  or  with  others,  were,  in 
my  opinion,  incompatible  with  sanity,  nor  indications  of  any 
known  mental  disease.  The  evidence  brought  forward  was 
such  as  to  show  that  the  prisoner  had  been  brought  up  badly, 
and  had,  from  the  time  he  began  to  look  out  for  himself,  lived 
as  a  parasite  upon  society,  making  use  of  all  methods  of 
shrewdness  and  deception  to  gain  shelter  and  food,  until  he 
found  his  path  in  life  becoming  more  and  more  difficult  to  fol- 
low, and  then  he  resorted  to  more  desperate  methods.  Like 
the  murderers  in  Macbeth  he  might  have  said  : 

"  I  am  one,  my  liege, 
Whom  the  vile  blows  and  buffets  of  the  world 
Have  so  incensed  that  I  am  reckless  what 
I  do  to  spite  the  world." 


And  I  another,  so  weary 
With  disasters,  tugged  with  fortune, 
That  I  would  set  my  life  on  any  chance 
To  mend  it,  or  be  rid  on  't." 


When  we  analyze  his  actions  I  do  not  think  there  is  any 
alternative  for  us.  We  can  only  say  that  his  crowning  crime 
was  the  culmination  of  uncor<":;olled  wickedness,  and  his  convic- 


66  MEDICAL   JURISPRUDENCE. 

tion  and  sentence  the  natural  result  of  the  failure  of  his  lasi 
desperate  scheme. 

Thomas  Beggs  Gilpin,*  in  speaking  of  the  psychology  of 
crime,  says,  "  It  matters  not  what  may  be  the  character  of  the 
crime  ;  it  may  be  arson,  it  may  be  rape  :  the  first  successful 
gratification  of  vindictive  feeling  leads  by  similar  progression 
to  tiie  one  ;  the  first  flirtation  of  simple  sensuality,  unchecked, 
if  not  encouraged,  leads  by  the  like  gradation  to  the  other  ;  in 
all  cases  progress  from  venial  to  bad,  from  bad  to  worse,  and 
thence  to  extremes,  is  the  invariable  trait  of  a  criminal  career  ; 
consequences  are  first  calculated  with  anxiety,  then  merely 
weighed  against  immediate  gain,  and  finally  disregarded  alto- 
gether." 

There  are  thousands  of  men  at  large  to-day  who  display  all 
the  eccentricity  of  Guiteau,  but  their  actions  are  as  impulsively 
good,  or  at  least  their  intentions  are  as  well  meant,  as  his  were 
bad,  and  still  they  are  not  called  insane.  In  some  cases  these 
persons  are  reformers,  with  projects  in  every  way  as  absurd  as 
any  of  Guiteau's.  What  can  be  said  of  the  educated  individual, 
for  example,  who  advocates  the  abolition  of  vaccination  ? 

Guiteau  is  only  a  shrewd  scamp,  with  the  plausibility  of  an 
Alfred  Jingle  in  swindling  his  boarding-house  keepers,  and 
evading  the  payment  of  his  debts  ;  the  visionary  enthusiasm  of 
Micawber  or  Colonel  Sellers  ;  the  cant  and  hyprocrisy  of 
Aminadab  Sleek  or  Uriah  Heap  ;  the  ambition  of  Erostratus, 
and  the  murderous  manners  of  Felton,  who  assassinated  the 
Duke  of  Buckingham,  of  whose  crime  the  killing  of  Garfield 
was  an  almost  exact  counterpart. 

None  of  his  "  delusions  "  were  akin  to  those  of  general 
paresis  of  the  insane,  for  in  that  disease  there  is  no  reasonable 
basis  whatever,  and,  moreover,  if  Guiieau  is  a  general  paretic, 
as  Dr.  Folsom  suggested  in  a  communication,  his  boasting  and 
immense  projects  have  been  expressed  for  at  least  twenty 
years,  and  there  are  few  cases  of  general  paresis  that  live 
beyond  the  tenth  year  of  the  disease,  and  they  nearly  all  end 
fatally  in  three  or  four  years,  or  less.  Guiteau's  projects  were, 
as  a  rule,  substantial,  and  were  at  some  time  realized. 

The  Intcr-Occan  scheme  was  a  pronounced  success  ;  the 
Theocraf,  conducted,  perhaps,  in  a  more  modest  way  than 
Guiteau  might  have  wished,  had  an  existence  of  several  years 
as  the  JVcw  York  Daily  IVii/iess,  a  small  religious  daily  paper ; 
and  even  his  last  and   most  fatal  "dchision  "  was  verified,  for 


*  Forbes  VVinslow's  Joutnal of  Medicine,  vol.  v.,  p.  177. 


THE    LEGAL    RELATIONS    OE    INSAMXV.  67 

he  did '*  unite  the  Republican  party,"  and  his  act  has  thor- 
oughly changed  the  features  of  American  poHtics.  In  some 
countries  where  a  president  is  assassinated  every  year  or  two, 
he  might  even  have  become  the  martyr  lie  expected  to  be,  but, 
unfortunately  for  him,  his  own  was  not  one  of  these. 

Dr.  Folsom*  very  aptly  says,  "  His  shooting  of  the  President 
was,  to  a  certain  extent,  the  logical  result  of  bad  training,  char- 
acter somewhat  unscrupulous,  enormous  self-conceit,  self-will, 
disappointment  in  not  getting  office,  cowardice,  extreme  politi- 
cal partisanship,  delusions  or  deceit  regarding  religion,  despera- 
tion of  poverty,  expectation  of  personal  gain,  love  of  notoriety, 
and  hope  of  praise  from  the  '  stalwarts,'  " — but  are  these  neces- 
sarily expressions  of  insanity  ? 

While  I  do  not  agree  with  an  English  criticism  that  "  Guiteau 
is  a  type  of  American  civilization,"  I  do  believe  that  in  a  new 
country  as  large  and  great  as  ours,  a  land  in  which  religious 
and  political  liberty  is  as  universal  as  it  is  in  this,  and  in  which 
the  creed  that  "  one  man  is  as  good  as  another  "  has  so  many 
believers,  there  must  be  many  Guiteaus  ;  not  Guiteaus  who 
necessarily  kill  a  president,  but  eccentric  individuals  with 
"badly  arranged  minds."  In  many  sections  of  the  country 
there  are  religious  sects  and  communities  whose  teachings  are 
as  immoral  and  unstable  as  that  of  the  establishment  at  Oneida, 
from  which  the  assassin  graduated.  In  the  section  in  which 
the  elder  Guiteau  lived  I  understand  that  a  large  number  of 
people,  even  to-day,  hold  that  with  careful  bodily  care  life  may 
be  prolonged  indefinitely  ;  but  the  counsel  for  the  prisoner 
inadvertently  proved,  in  alluding  to  the  elder  Guiteau's  views 
on  this  subject,  as  an  element  of  his  insanity,  that  he  neverthe- 
less made  a  will  and  insured  his  life.  In  Massachusetts  there 
is  a  body  of  "  Second  Adventists,"  many  of  whom,  1  under- 
stand, fully  approved  at  the  time  the  crime  of  Freeman,  who 
sacrificed  his  child  ;  and  in  other  parts  of  the  country  there 
are  colonies  of  equally  ignorant  and  fanatical  people,  whose 
teachings  and  practices  are  calculated  to  stimulate  the  baser 
emotions  of  the  ignorant,  and  send  them  adrift  to  prey  upon 
society,  with  the  most  loose  views  both  religious  and  ethical. 

Guiteau's  behavior  subsequent  to  his  conviction  is  too  well 
known  to  be  recalled,  and  his  appearance  upon  the  gallows  was 
fully  in  consonance  with  his  previous  life.  He  was  a  hardened 
yet  weak  wretch,  and  the  same  spirit  which  led  him  during  the 
trial  to  express  his  vanity  and  allude  to  the  attention  of  certain 

*  Boston  Medical  and  Surgical  Journal,  February  i6,  1882,  page  151. 


1         of"*  „     ' 


68  MEDICAL    JURISPRUDENCE, 

"  ladies  "  prompted  the  verses  and  the  sickening  "  last  words  " 
upon  the  scaffold.  Such  scenes  are  by  no  means  novel,  and 
the  murderer's  parting  speech  in  other  cases  where  insanity  is 
not  hinted  at,  is,  as  a  rule,  a  mixture  of  cant  and  blasphemy. 
Only  a  few  weeks  after  Guiteau's  hanging  a  negro  murderer  in 
St.  Louis  cried  out  as  the  trap  was  sprung  :  "  I'm  going  to  the 
'  Lordy '  like  Charlie  Guiteau."     (See  Appendix  D.) 

Is  this  moral  depravity  necessarih'  insanity  ?  I  am  sure  not. 
It  is  not  folie  raisonante,  because  the  man's  weaknesses  were 
many — he  was  consistently  bad,  and  his  false  premises  were 
those  adopted  by  the  thousand  of  miserable  inmates  of  our 
States  prisons  and  penitentaries. 

Dr.  Mayo  *  in  a  valuable  article  thus  alluded  to  persons  of 
this  class  : 

"  Doubtless  these  symptoms,  wavering  between  eccentricity 
and  insanity,  but  combined  with  vicious  propensities,  are  often 
received  into  an  asylum,  when  a  prison  would  be  more  ap- 
propriate. I  was  told  lately  by  Mr.  Povvnall,  chairman,  I  think, 
of  the  Brentford  Quarter  Sessions,  the  following  anecdote  re- 
specting Oxford,  who  afterwards  attempted  the  Queen's  life. 
Sometime  before  that  act  he  was  brought  before  Mr.  Pownall 
and  another  magistrate,  on  account  of  some  very  eccentric 
cruelty  shown  towards  some  fowls  ;  and  for  this  offense  let  off 
with  a  reprimand.  Seeing  Mr.  Pownall  some  time  afterwards, 
when  in  the  penal  wards  of  Bedlam — 'Had  you,' said  Oxford 
to  that  gentleman — 'had  you  punished  me  when  I  was  brought 
before  you  for  that  former  offense,  I  should  not  now  have  been 
here.' 

"In  this  point  of  view  the  case  of  the  Hon.  Mr.  Tuchet  was 
probably  a  sad  instance  of  mismanagement,  both  legal  and 
educational.  Mr.  Tuchet  wantonly  shot  the  marker  in  a 
shooting  gallery.  Before  this  event,  while  this  young  gentle- 
man was  on  the  town  in  a  state  of  progressively  increasing  dis- 
content and  enmii,  if  the  eye  of  science  had  been  brought  to 
bear  upon  him,  the  observer  might  have  possibly  seen  good 
reason  for  calculating  upon  liis  exhausting  his  powers  of  self- 
control  so  far  as  to  acquire  good  grounds  for  claiming  the  pro- 
tection of  the  law,  before  he  had  rendered  his  claim  to  that 
protection  questionable  or  inappropriate  by  an  act  which,  at 
that  stage  of  abnormal  conduct,  assumed  all  the  frightful  char- 
acter of  murder.  It  is  difficult  without  more  knowledge  than 
we  ]X)Ssess  of  the  antecedents  of  this  gentleman  to  substantiate 

*  The  Journal  of  Psychological  Medicine.  A.Dri]    T.sru. 


THE    LEGAL    RELATIONS    OF    INSANITY.  69 

completely  our  hypothesis,  but  it  may  be  plausibly  suggested 
that  he  was  protected  by  the  decision  of  a  court  of  justice 
from  punishment  for  a  great  crime  on  the  plea  of  insanity,  in- 
stead of  being  prevented  from  committing  that  or  similar 
crimes  by  early  surveillance  and  detention.  Meanwhile  the 
punishment  which  he  escaped  was  legally  deserved,  as  he  un- 
questionably well  knew  the  murderous  nature  of  the  act  which 
he  committed  at  the  moment  of  commission." 

Genius  and  Insanity. — Lack  of  steadiness  and  concentra- 
tion, effervescent  genius,  hobby-riding  and  crotchety  versatility 
are  the  mental  traits  of  many  of  these  unbalanced  persons  of 
weak  mind,  and  we  find  in  the  ranks  many  of  the  reformers 
who  occasionally  startle  the  world,  and  keep  society  alternating 
between  discomfort  on  one  hand,  and  the  enjoyment  of  the 
ridiculous  on  the  other  ;  as  well  as  the  fools  who  delight  in 
keeping  themselves  prominent  in  the  press  and  elsewhere. 

Examination  of  the  Patient. — The  medical  man  should 
carefully  investigate  the  patient's  condition.  He  should  de- 
termine by  questions  directed  to  draw  out  the  alleged  lunatic 
what  his  relations  towards  and  opinions  of  his  family  are,  and 
whether  he  believes  himself  the  subject  of  persecution  or  con- 
spiracy. He  should  note  whether  the  patient  is  preoccupied, 
or  excitable  and  communicative  ;  whether  he  is  incoherent  or 
violent ;  whether  he  lacks  concentration  and  betrays  a  loss  of 
memory.  Skillful  questions  directed  to  show  the  business  re- 
lation and  capacity  of  the  patient  should  be  put,  and  the  re- 
ligious tendencies  or  changes  should  be  inquired  into.  Altera- 
tions in  dress,  personal  untidiness  or  disregard  of  the  bodily 
wants  often  exist  and  should  be  noted.  Besides  the  speci- 
mens of  handwriting  should  be  examined  and  compared  with 
letters  written  in  health. 

The  physical  changes  if  any,  are  to  be  looked  for.  The 
presence  of  paralytic  obliteration  of  the  facial  folds,  the  devia- 
tion of  the  tongue,  the  shriveled  ear  of  chronic  insanity,  un- 
equal dilatation  of  the  pupils,  the  dryness  or  scurfyness  of  the 
skin  under  the  hair,  and  the  posture  and  method  of  gesticulation 
are  common  in  insanity.  Speech  disturbances,  whether  ataxic 
or  aphasic,  are  valuable  signs  of  insanity  dependent  upon  de- 
generative disease  of  the  brain,  and  often  are  confirmatory 
symptoms. 

Tardieu's  Formula. — Tardieu  lays  down  the  following 
formula  for  examinatioa ; 


70  MEDICAL    JURISPRUDENCE. 

A.  Mental  state. — Three  orders  of  facts  should  be  investi- 
gated. I.  The  intellectual  troubles.  2.  The  perversion  of 
the  affective  faculties  and  the  instincts  3.  Alteration  of  the 
sensorial  functions. 

The  intellectual  disorders  consist  in  a  general  derangement, 
marked  by  delirious  conceptions  with  complete  abolition  of 
judgment,  memory  and  conscience  ;  afterwards  commonly  in 
a  partial  derangement  of  understanding.  From  a  medico- 
legal point  of  view  the  most  direct  and  immediate  result  of  the 
disorder  of  the  intellectual  faculties  is  a  perversion  of  will 
and  a  resulting  impairment  in  action,  either  in  an  absence  of 
control  or  purpose,  or  in  action  which  bears  the  impress  of  in- 
coherent or  erroneous  ideas. 

Disorder  of  the  affective  faculties  are  constant  in  insanity. 
There  is  more  or  less  alteration  of  affections  and  instincts. 
The  more  natural  sentiments  are  abolished  or  perverted,  and 
the  instinct  is  sometimes  abolished  as  well. 

The  sensorial  troubles  are  singular  and  characteristic  in 
insanity  and  hallucinations  and  illusions  are  the  most  im- 
portant. 


B.  Somatic  state.  The  position,  attitude,  walk,  gestures, 
the  dress,  malformation  of  head,  physiognomy,  expression. 
*  *  ■*  *  The  circulation  and  temperature 
are  diminished  in  the  inaction  of  melancholia,  and  increased 
in  the  agitation  of  mania.  The  general  sensibility  is  exalted 
or  perverted  in  monomania,  or  diniinished  to  the  point  of 
analgesia  in  lypemania.  The  spasms,  the  startings,  the  mus- 
cular twitchings,  the  partial  paralyses  of  sensation  and  motion, 
indicate  a  grave  alteration  of  the  nervous  centers.  The  em- 
barrassment of  si)eech,  the  unequal  dilatation  of  the  pupils,  the 
permanent  deviation  of  the  uvula,  the  ataxia  of  movement, 
suggest  general  paresis  ;  finally  we  are  to  recognize  all  the  symp- 
toms which  are  connected  more  or  less  directly  with  mental  alien- 
ation. Vertigo,  muscte  volitantes,  cutaneous  and  neuropathic 
manifestations.  The  mobility  of  the  tongue,  and  scars  which 
may  l)e  indicative  of  epilepsy,  or  traces  of  cicatrices  which  may 
be  the  result  of  attempted  suicide. 

Physical  Tests. — We  should  make  careful  examination 
with  instruments  of  precision.  'J'he  ophthalmoscope  should 
be  employed.  The  condition  of  the  tendon-reflex  should  be 
ascertained,  and  various  tests  should  be  brought  into  play   to 


THE    LEGAL    RELATIONS    OF    INSANITY,  7I 

determine  the  possible  evidences  of  organic  nervous  disease. 
The  patient's  family  history  ;  previous  habits,  vicious  or  other- 
wise ;  the  progress  of  his  disease  and  its  complications  are  to  be 
gone  into. 

Duties  of  tlie  Medical  Expert. — Whether  in  civil  or 

criminal  cases  we  are  to  determine  the  influences  that  may 
destroy  the  responsibility  of  an  individual,  and  it  should  always 
be  borne  in  mind  that  the  offices  of  the  physician  are  only  those 
in  which  he  is  warranted  in  forming  an  opinion  relative  to  the 
enfeeblement  of  mind  through  disease.  Questions  of  law  do 
not  concern  him,  and  the  courts  will  not  permit  him  to  express 
more  than  what  he  knows  regarding  the  medical  aspects  of  the 
case.  He  should  always  remember  the  dignity  of  his  calling, 
and  never  lose  his  temper,  no  matter  how  much  galled  he  may 
be  by  the  impertinence  of  the  opposing  counsel,  who  is  not 
always  a  gentleman.  He  should  however  never  be  flurried, 
never  give  hurried  answers,  and  should  demand  time  for  his  full 
answer  if  "choked  off"  or  interrupted.  He  should,  on  the 
other  hand,  never  show  an  eagerness  to  testify,  or  an  enthu- 
siasm in  espousing  the  cause  of  the  side  upon  which  he  may 
be  employed.  His  testimony  should  be  given  in  a  cool,  im- 
partial manner.  He  should  be  on  the  alert  and  avoid  the 
possibility  of  being  trapped  by  his  ingenious  legal  opponent. 
A  favorite  method  of  some  lawyers  is  to  dissect  a  hypothetical 
question  and  demand  answers  to  isolated  portions.  By  this 
means  it  is  possible  to  get  a  truthful  negative  answer  to  many 
of  the  elements  of  real  insanity.  "  Do  you  consider  the  fact 
that  a  man  is  slovenly  in  his  habits  an  infallible  sign  of  in- 
sanity ?  "  may  be  asked,  and  the  witness  of  course  answers, 
"no  " — while  this  very  untidiness  taken  with  other  indications, 
may  be  a  very  important  elemem  of  the  mental  disease. 
The  medical  man  should  therefore  be  on  his  guard  and 
refuse  in  such  a  case  to  give  any  thing  but  a  qualified 
answer. 

Tricks  of  Counsel. — AH  manner  of  dodges  may  be  re- 
sorted to,  as  asking  the  witness  for  example,  if  he  has  read 
such  and  such  authorities,  while  in  reality  no  such  works  are  in 
existence.  He  should  avoid  being  drawn  into  discussions  upon 
various  other  subjects  which  are  foreign  to  the  case  in  hand, 
and  if  these  be  not  strictly  medical,  the  witness  may  refuse  to 
answer — at  least  so  far  as  he  may  be  made  to  pose  as  an  expert 
in  some  other  field.  In  one  case  I  was  asked  in  reference  to  my 
views  upon  theological  subjects  and  this  I  refused  to  go  into 


72  MEDICAL    JURISPRUDENCK. 

except  in  the  most  superficial  way.  It  is  unwise  to  pose  either 
as  a  radical,  or  as  a  person  of  more  than  ordinary  ability,  and 
therefore  do  not  tincture  your  answers  with  any  thing  extra- 
neous. A  man  who  declares  himself  an  agnostic  is  apt  to 
injure  his  case,  and  render  himself  ridiculous.  So,  too,  he  is 
not  warranted  in  ventilating  any  extreme  views  or  theories 
that  do  not  bear  the  stamp  of  proof.  The  flippant  witness  is 
sure  to  injure  his  case  by  trying  to  raise  a  laugh  or  by  an 
attempt  at  repartee.  He  will  find  to  his  cost  that  some  sober 
old  lawyer  on  the  other  side  is  quietly  listening  and  awaiting 
his  chance  to  turn  the  laugh  upon  the  unfortunate  jester,  and 
to  create  in  the  minds  of  the  jury  a  prejudice  which  is  ex- 
■tremely  uncomplimentary,  as  well  as  injurious  to  the  case.  In 
fact  a  thoughtless  answer  may  destroy  the  weight  of  all  the 
sound  testimony  that  may  have  been  given  before. 

Medical  witnesses  are  very  often  asked  whether  insanity  can 
exist  without  disease  of  the  brain  and  the  assumption  is  tl  at  it 
can.  While  it  behooves  the  medical  man  to  be  exceedingly 
cautious,  he  may  safely  say  that  although  our  instruments  of 
research  do  not  always  reveal  to  us  the  signs  of  disease  after 
death,  there  can  be  no  doubt  but  that  insanity  is  always  due  to 
some  organic  change.  So  far  we  cannot  with  great  positiveness 
recognize  distinctive  appearances,  yet  the  majority  of  chronic 
cases  at  least  are  attended  by  well  marked  changes.  It  cannot 
be  denied  on  the  other  hand  that  extensive  disease  of  the  brain 
may  exist  without  any  marked  intellectual  disturbance.  ySee 
Post-AIoi  tevi  Exainiiiation  of  the  I/isatie.) 

Legal  Terms. — There  are  various  terms  used  in  the  law 
which  should  be  borne  in  mind,  not  because  they  are  always 
consistent  with  medical  facts,  but  for  the  reason  that  the 
medical  witness  may  answer  more  intelligently  with  the  possess- 
ion of  such  knowledge, — and  here  another  word  of  caution  may 
be  given  to  those  who  are  inclined  to  wander  into  the  fields  of 
a  profession  to  which  tliey  do  not  belong.  The  medical  man 
called  to  the  stand  should  confine  himself  to  insanity  as  a  dis- 
ease, and  should  avoid  the  floundering  which  must  follow  when 
he  uses  legal  terms,  and  attempts  legal  distinctions. 

Illusions  are  sensory  perversions  and  have  for  their  creation 
some  outside  suggestion.  Real  things  are  distorted.  An  indi- 
vidual looks  at  a  post  and  sees  two,  or  at  the  pictures  upon  the 
wall  and  declares  that  the  figures  move.  He  mir^takes  shadow 
for  substance.  He  considers  the  whistling  ot  the  wind  to  be 
that  of  men  in  the  street,  or  believes  that   the  contact  of  his 


itib.   LILGAL,   Kh-LAllUNS    OF    INSANITY  73 

clothing  with  the  skin  is  that  produced  by  ants  or  other  insects. 
The  tricks  of  the  magician  or  clairvoyant  are  examples  of  illu- 
sion, and  our  senses  deceive  us  every  day  in  a  variety  of  ways. 
When  the  illusion  is  persistent  and  incontrovertible,  and  when 
connected  with  various  errors  in  reasoning  capacity,  it  becomes 
an  indication  of  mental  unsoundness. 

Hallucinations  are  perverted  perceptions  without  material 
bases,  and  like  delusions  may  be  simple  or  insa?ie.  Through 
disease  of  the  organs  of  sense  or  receptive  apparatus  distorted 
impressions  are  conveyed  to  the  ideational  centers.  If  the  indi- 
vidual is  able  to  correct  them  then  they  will  have  no  significance, 
but  if  he  does  not  appreciate  their  false  character,  and  if  he 
elaborates  false  ideas  the  case  is  different.  If  the  patient  says 
that  he  hears  voices  which  say  horrible  things  to  him,  or  sees 
purely  imaginary  personages,  the  symptom  has  a  dangerous 
significance.  The  individual  who  believes  he  sees  the  Almighty 
and  proceeds  to  detail  a  conversation  he  has  had  with  him,  has 
an  insane  hallucination  connected  with  a  delusion.  The  insane 
character  of  the  hallucination  is  further  increased  by  its  asso- 
ciation with  mental  perversion  of  other  kinds.  Insane  people 
frequently  hear  voices  speaking  through  walls,  waste  pipes  and 
imaginary  telephones,  and  it  is  not  uncommon  to  find  a  patient 
in  a  fixed  expectant  attitude  listening  to  some  fancied  commu- 
nication. 

Brierre  de  Boismont  in  speaking  of  hallucinations  in  connec- 
tion with  insanity,  says  : — 

*  "  Out  of  178  persons  who  presented  this  complication,  30 
— under  the  influence  of  false  sensations — threatened  death, 
struck,  overturned,  wounded  their  pretended  enemies,  attempted 
to  kill  themselves,  and  if  deplorable  accidents  did  not  take 
place,  it  was  simply  because  they  were  promptly  placed  under 
restraint.  Hallucinatory  perceptions  and  illusions  of  hearing 
lead  to  quarrels,  to  extreme  anger  and  fury,  and  to  violence  in 
considerable  proportions.  One  of  our  patients,  to  whom  in- 
sulting words  were  addressed,  flew  each  time  into  a  violent 
rage  ;  he  exclaimed  that  there  had  been  enough  of  it,  and  that 
he  must  kill  somebody.  This  patient  is  all  the  more  dangerous 
because  his  attacks  are  instantaneous.  Were  he  not  constantly 
accompanied  by  his  servant,  some  accident  would  have  oc- 
curred ;  yet  despite  his  excitement,  he  knov.'s  what  he  is  doing. 

"  However  strict  may  be  the  surveillance,  these  auditory  illu- 
sions constantly  occasion  struggles  between  the  insane,  and 
more  or  less  serious  injuries.  A  merchant  used  to  hear  two 
voices  ;  one  polite,  the  other  insulting.     With  the  former  he 


74  MJiDlCAL    JURISPRUDENCE. 

was  amiable,  cheerful,  ready  to  oblige  ;  but  when  it  was  the 
turn  cf  the  latter,  he  became  formidable — his  strength,  already 
great,  was  doubled.  During  one  of  his  crises  he  seized  in  an 
instant  a  stake,  and  he  had  to  be  surrounded  before  it  could  be 
taken  from  him.  Life  is  often  endangered  by  these  kinds  of 
illusions.  Two  ladies  unexpectedly  flew  at  a  female  employed 
in  the  establishment,  and  attempted  to  murder  her;  a  vigorous 
struggle  became  necessary.  A  patient,  insulted  by  these  voices 
threw  himself  out  of  the  window.  We  attended  once  a  mer- 
chant in  whose  ears  the  word  bankruptcy  continually  resounded. 
He  energetically  protested  against  this  insult,  and  would  have 
committed  suicide  had  not  precautions  been  taken. 

"  Accusations  of  theft,  of  abused  confidence,  of  perjury,  and 
voices  addressed  to  the  victims  of  hallucinations  have  fre- 
quently led  to  avowals  from  them.  '  It  is  true  '  they  admit,  I 
have  to  add  fresh  facts  to  those  we  have  published  to  prove  that 
remorse  may  be  a  determinating  cause  of  madness  and  halluci- 
nation. A  tradesman  who  until  then  had  deserved  the  esteem  of 
all  who  knew  him,  heard  voices  reproaching  him  for  a  bad 
action.  These  voices  left  him  no  moment  of  repose,  though  his 
family  and  friends  were  prodigal  of  consolation.  1  was  called 
in  and  tried  to  tranquillize  him  ;  every  thing  denoted  impending 
madness.  He  went  up-stairs  to  go  to  bed.  A  few  minutes 
afterwards  he  was  found  hung. 

"  A  clerk,  about  thirty  years  of  age,  was  brought  eighteen 
years  ago  to  my  establishment  in  the  Rue  Nueve  St.  Genevieve. 
It  was  suspected  that  he  was  simulating  insanity,  'i'he  house 
in  which  he  was  employed  had  discovered  an  embezzlement  of 
about  twelve  thousand  francs,  respecting  which  he  could  not 
or  would  not  give  any  information.  Three  hours  after  his 
arrival  he  threw  into  the  fire  a  set  of  chimney  ornam.ents.  I 
asked  him  what  had  induced  him  to  commit  such  a  foolish 
action  ;  he  was  some  time  before  replying  to  me  ;  then  he 
said  in  a  low  voice  and  in  a  mysterious  manner,  '  He  com- 
manded me  to  do  it.'  From  that  moment  it  was  impossible  to 
get  a  word  out  of  him,  and  he  ended  by  falling  into  a  state  of 
complete  insanity." 

Disorderly  Conduct  Explained  by  Hallucinations. — 

The  police  reports  from  time  to  time  contain  accounts  of 
arrests  for  disorderly  conduct,  and  sometimes  there  is  no  ex- 
planation for  the  violent  acts  of  the  prisoner.  Occasionally  he 
is  "  committed  for  medical  examination,"  but  more  often  he  is 
hurried  off  to  the  workhouse  or  penitentiary  and  perhaps  pro- 


■IHE    LEGAL    RELATIONS    OF    INSANITY.  75 

nounced  **  drunk  and  disorderly,"  while  in  truth  this  disturb- 
ance of  the  public  peace  may  be  entirely  due  to  the  existence 
of  hallucination.  Brierre  de  Boismont*  says  :  "This  false  sen- 
sation leads  to  desperate  consequences.  A  person,  a  prey  to 
this  delusion,  flew  at  a  friend,  whom  he  took  for  a  thief, 
knocked  him  down,  thrashed  him  soundly,  and  called  him  a 
scoundrel.  In  our  estabUshments  patients  are  often  seen  who 
try  to  beat  other  inmates  whom  they  consider  enemies.  We 
attended  a  maniac  who,  believing  himself  surrounded  by  malig- 
nant beings,  continually  wished  to  rip  up  his  companions. 
Many  of  those  confided  to  us  had  struck  policemen  and  others 
because  they  had  assumed  the  form  of  enemies  ;  for  the  same 
reason  some  lunatics  beat  their  keepers  and  severely  wound 
them.  One  had  his  face  mutilated  by  a  decanter  ;  when  assist- 
ance came  he  was  blinded  by  blood  and  could  not  defend 
himself." 

Delusions  are  simple  or  ifisane.  A  false  belief,  which  is  not 
tenaciously  adhered  to  when  proper  negative  evidence  is  pro- 
duced, is  a  simple  delusion  and  need  not  be  a  mark  of  insanity. 
But  when  the  individual  believes  in  something  which  originates 
and  exists  only  in  his  own  disordered  imagination,  and  which 
he  will  not  permit  to  be  controverted  by  indubitable  evidence, 
this  may  be  said  to  be  an  insane  delusion.  A  person  may 
simply  display  bad  judgment  in  the  formation  of  opinion  ;  or 
he  may  believe  that  he  has  committed  the  "  unpardonable  sin," 
or  that  he  is  the  object  of  a  vile  and  well  arranged  conspiracy, 
or  that  he  has  changed  his  identity.  If,  when  confronted  with 
contradictory  proof,  he  still  persists  in  clinging  to  his  delusion, 
and  especially  if  he  acts  upon  it  to  the  detriment  of  himself 
or  some  one  else,  he  may  fairly  be  considered  insane. 

Delusion  of  this  last  kind  is  clearly  evidence  of  mental  un- 
soundness. In  legal  matters  the  relation  of  the  delusion  is 
however  the  real  issue.  If  such  a  delusion  prevents  the  indi- 
vidual from  exerting  a  "  rational  act  of  volition,"  which  for 
instance  is  pertinent  to  the  disposal  of  his  property,  then  he 
does  not  possess  testamentary  capacity,  and  is  so  far  of  un- 
sound mind.  Such  a  delusion  may  arise  in  relation  to  his 
family,  and  he  may  through  disease  entertain  a  bitter  hatred 
for  persons  who  are  entitled  to  gratitude  and  consideration. 
Delusions  which  lead  to  acts  of  violence  are  also  equally  of  im- 
portance, and  more  than  one  writer  upon  medical  ^urispru- 
dence  has  held  that  "  all  insanity  was  manifested  in  morbid 

*  Journal  of  Psychological  Medicine,  vol.  ix. 


Jt>  MEDICAL    JURISPRUDENCE. 

beliefs,  and  that  consequently  delusion  was  a  good  test  of 
insanity."  The  question  of  responsibility,  however,  depends 
upon  the  connection  of  the  act  with  the  particular  delusion. 

It  is  the  province  of  the  medical  man  to  study  the  relation 
of  delusion  with  other  evidence  of  insanity,  with  change  in 
habits,  morals,  and  the  many  perversions  that  go  to  make  up 
the  picture  of  mental  disease. 

Delusions  not  Necessarily  Expressed  in  Conversa- 
tion.— Delusions  need  not  necessarily  be  expressed  in  actual 
words  but  the  insane  person  may  suggest  for  instance  his  belief 
that  he  is  some  one  else  by  his  manner,  behavior  or  dress.  He 
may  strut  about  wearing  upon  his  breast  decorations  that  he  has 
constructed  from  bits  of  bright  metal  and  rags,  or  he  may  per- 
sonify a  member  of  the  Trinity.  The  possessor  of  a  delusion 
is  usually  restless  and  absorbed  only  in  himself.  The  expression 
of  the  face,  the  manner  of  speaking  and  a  thousand  and  one 
little  actions  betray  the  extstence  of  a  delusion  or  series  of 
delusions.    (See  Appendix  E  ) 

Concealed  Delusions. — The  insane  are  often  cunning  to  a 
degree  it  is  difficult  to  imagine.  I  have  known  of  many  cases 
in  which  the  patient  who  appeared  in  court  under  writ  of 
habeas  corpus  made  so  good  an  appearance  and  under  skillful 
coaching  refrained  from  expressing  the  delusion  that  would 
disclose  his  insanity  to  the  jury  that  he  has  been  discharged, 
and  every  Superintendent  of  an  asylum  has  had  cases  of  this 
kind. 

In  well  marked  cases  of  insanity  of  advanced  stages,  the  evi- 
dence of  the  disease  cannot  be  restrained,  but  in  the  masked 
intellectual  forms  it  is  possible  for  the  lunatic  to  resort  to  in- 
genious reasoning.    This  form  of  mental  perversion  is  known  as 

Reasoning  Mania^  manie  raisonnante  (the  manie  sans  delire 
de  Pinel)  [^Sce  Reasoning  Jnsanity)  has  been  applied  to  a  form 
of  insanity  in  which  the  intellectual  faculties  are  less  affected 
than  the  others,  and  many  of  the  so-called  cases  of  moral  insanity 
are  those  in  which  false  conclusions  are  reached  and  as  a  result 
ot  the  deprivation  of  judgment  and  the  false  exercise  of  will  the 
patient  may  commit  some  act  of  violence  which  is  almost 
incredible,  because  the  ordinary  mental  condition  of  the  indi- 
vidual seems  to  be  unaffected..  The  plans  laid  by  such  people, 
the  pretexts  used  to  justify  the  crime,  and  the  means  used,  all 
a])j)ear  at  first  sight  to  stamp  him  as  a  responsible  being,  but 
usually  there  arc  striking  mental  inconsistencies  which  indicate 
insanity 


THE    LEGAL    RELATIONS   OF   INSANITY.  7? 

The  patient's  troubles  always  begin  with  change  m  temper 
and  disposition.  He  grows  quarrelsome,  disorderly  and  vio- 
lent. The  will  of  such  subjects  is  enfeebled  and  they  are  incon- 
sistent and  act  from  impulse.  Sexual  desire  is  expressed  in 
attempts  at  rape  or  bestiality,  jealousy  by  sudden  assaults,  and 
the  individual  is  dominated  by  his  passions. 

Dagonet,*  in  speaking  of  the  subjects  of  vianie  raisonnante, 
says  that  a  prolonged  and  attentive  examination  of  the  insane 
of  this  class  will  impress  the  observer  with  the  fact  that  the 
intellectual  vigor  of  the  patients  is  more  apparent  than  real. 
In  fact,  the  patients  reason  logically  in  a  given  circle,  but  when 
the  conversation  is  prolonged  or  when  other  subjects  foreign 
to  their  ordinary  line  of  thought  are  introduced,  they  will  not 
be  slow  in  manifesting  fixed  ideas,  strange  illusions,  errors  in 
perception,  false  appreciations,  exaggerated  conceit  and  a  variety 
of  other  indications  of  a  morbid  mental  condition.  I  re- 
cently examined  a  patient,  with  Dr.  Clymer,  wlao  suffered  from 
this  form  of  mental  trouble.  He  freely  admitted  that  his  in- 
sane acts  were  the  result  of  reasoning,  and  that  during  the  night 
he  would  bring  himself  to  believe  in  the  propriety  of  making 
certain  purchases,  or  doing  things  he  afterwards  regretted. 
Upon  one  occasion  he  walked  down  Broadway  and  pur- 
chased several  umbrellas  and  other  things  he  was  already  pro- 
vided with.  He  had  spent  a  considerable  sum  of  money  in  a 
few  weeks,  and  when  we  saw  him,  had  begun  to  seriously  con- 
sider the  performance  of  acts  more  harmful  to  himself  and 
society. 

Lucid  Intervals. — In  some  of  the  common  forms  of  in- 
sanity there  are  remissions  in  the  course  of  the  disease,  during 
which  the  patient  is  apparently  sane.  These  periods  must  not 
be  confounded  with  the  temporary  remissions,  which  occur  in 
mania  for  instance,  but  we  do  find  them  notably  in  general  pare- 
sis of  the  insane.  Legally  defined,  a  lucid  interval  consists  of 
a  period  during  which  the  patient  regains  the  power  of  using  his 
judgment  in  the  management  of  affairs.  It  is,  however,  question- 
able whether  an  established  form  of  insanity  ever  has  remissions 
during  which  the  patient  is  entirely  sane.  Mania  has  remis- 
sions of  short  duration  during  which  the  individual  may  im- 
press the  bystanders  with  his  apparent  capacity,  but  medical 
men  hesitate,  and  justly  so,  to  admit  that  such  a  thing  as  a 
genuine  lucid  interval  exists.     It  cannot  be  denied  that  some 

*  Nouveau  traits  elementaire  et  pratique  des  maladies  mentales,  etc.,  H. 
Dagonet,  Paris,  1876,  p.  203. 


78  MEDICAL    JURISPRUDENCE. 

particular  illusion  disappears,  which  removes,  perhaps,  the  bias 
of  the  patient's  judgment  regarding  a  specific  act.  There  are 
cases  of  mental  disease  of  a  recurrent  form  which  are  charac- 
terized by  periods  during  which  the  patient  may,  with  some  in- 
telligence, conduct  his  affairs  or  preserve  his  relations  with 
society  in  a  creditable  manner  but  a  smoldering  fire  exists 
which  is  likely  to  break  out  when  least  expected. 

The  law  recognizes  the  right  of  the  individual  during  the  so- 
called  lucid  interval  to  make  a  will,  sign  an  obligation,  or  exer- 
cise his  civil  rights.  He  is  held  responsible  for  crimes  com- 
mitted during  such  a  period,  so  the  rule  works  both  ways,  and 
by  no  means  with  perfect  equity. 

The  plaintiff  in  a  suit  against  a  lunatic  who  is  supposed  to 
have  a  lucid  interval  is  required  to  substantiate  the  fact  that  the 
individual  was  sane  when  he  signed  a  particular  deed  or  con- 
tract. Under  these  circumstances  the  nature  of  the  written 
contract,  its  possible  amendation  and  correction  by  the  alleged 
lunatic,  should  be  examined,  and  the  facts  bearing  upon  the 
matter  in  hand  should  be  brought  out.  Upon  the  part  of  the 
defendant,  it  can  be  usually  shown  by  his  friends  and  legal  ad- 
visers, that  such  a  lucid  interval  is  only  a  partial  remis- 
sion. 

Contracts  made  by  tlie  Insane.— The  determination  of 

the  mental  condition  of  individuals  in  relation  to  the  validi- 
ty of  contracts  they  may  enter  into,  or  wills  they  may  make,  is 
frequently  necessary.  Insanity  is  always  a  convenient  excuse 
for  those  who  find  themselves  bound  by  distasteful  bargains,  or  a 
plea  presented  by  disappointed  relations  who  have  not  what  they 
consider  their  due,  when  the  estate  of  an  inconsiderate  testator 
is  divided.  A  large  number  of  the  cases  in  the  Surrogate's 
Court  are  contested  because  of  the  alleged  mental  incompeten- 
cy of  the  dead  man,  and  testimony  is  given  which  is  often  in- 
dicative of  any  thing  else  but  mental  feeblness.  Eccentricity  of 
conduct  and  dress  and  peculiarities  of  language  are  brought  to 
light  and  dignified  as  insane  symptoms,  and  the  skeleton  of 
many  a  closet  is  laid  out  in  the  court  room.  It  may  be  safely 
stated  that  two-thirds  of  all  the  suits  brought  to  set  aside  wills 
are  based  upon  the  flimsiest  ground  work. 

The  capacity  to  make  a  will  need  be,  according  to  the  law, 
dependent  upon  a  very  ordinary  state  of  mental  integrity.  The 
will  of  an  insane  man  who  may,  even  with  the  existence  of  con- 
spicuous mental  defects,  be  able  to  recognize  the  objects  of  his 
bounty  and  have  sufficient  intellectual  vigor  to  appreciate  the 


THK    LEGAL    RELATIONS    OF    INSANITY.  'jg 

extent  of  his  property,  and  dispose  of  it  properly,  is  frequently 
admitted  to  probate. 

Testamentary  Capacity. — We  are  to  investigate  the  con- 
dition of  the  testator  at  the  time  he  makes  his  will,  and  decide 
whether  his  disposing  capacity  is  affected  in  any  way — either 
by  the  natural  decay  of  old  age,  by  senile  dementia  or  other 
kinds  of  insanity — or  whether  there  exists  a  delusion  which  pre- 
vents him  from  intelligently  disposing  of  his  holdings. 

Wills  made  in  extremis  usually  have  no  value  in  the  eyes  o/ 
the  law,  and  these  as  well  as  contracts  are  often  contested. 

Tardieu,  Lasegue  *  and  other  French  writers  have  extensive- 
ly written  upon  the  mental  condition  of  the  individual  during 
the  last  moments  of  life.  They  announce  their  belief  that  either 
as  a  result  of  general  disease  or  insanity  the  brain  is  always 
affected  just  before  death,  and  intelligence  obscured  to  some 
extent,  so  that  the  capacity  for  will  making  is  at  least  doubt- 
ful. 

Old  Age  and  Dementia. — Much  has  been  said  about  the 
distinction  between  the  mental  decay  of  simple  old  age  and  the 
appearance  of  senile  dementia,  and  it  is  important  to  make  the 
distinction  when  we  are  called  upon  to  testify.  Dr.  Ray  says, 
"This  form  of  the  disorder,  or  senile  dementia,  is  so  often  the 
subject  of  medico-legal  inquiries,  especially  in  connection  with 
wills,  that  it  deserves  particular  attention.  Senile  dementia,  it 
must  be  recollected,  is  something  more  than  the  mere  loss  of 
mental  power  which  results  from  the  natural  decay  of  the  fac- 
ulties; it  is  not  only  feeble  but  it  is  deranged.  Were  it  not  so 
every  old  man  would  labor  under  a  certain  degree  of  dementia." 
Senile  dementia,  as  Prichard  has  written,  is  not  the  lot  of  old 
persons  universally,  though  it  is  a  condition  to  which  old  age 
has  a  tendency,  and  to  which  the  last  stage  of  bodily  decay 
approximates. 

Extreme  old  age  sometimes  prevents  the  testator  from  know- 
ing the  objects  of  his  bounty  and  from  mtelligently  disposing  of 
his  estate.  If  his  mind  is  so  weak,  either  through  disease  or  old 
age  that  he  may  be  tricked  or  swindled  ;  if  his  memory  and 
perception  are  so  blunted  as  to  prevent  him  from  knowing  the 
extent  or  condition  of  his  property  or  the  persons  to  whom  he 
wishes  to  give  it,  then  true  doubts  anse  in  regard  to  his  com- 
petency. Simple  old  age  does  not  necessarily  bring  with  it  in- 
capacity, for  there  are  men  who  have  attained  very  great  age 

*  Etude  de  la  folic,  p.  126. 


8o  MEDICAL    JURISPRUDENCE. 

without  any  suspicion  of  mental  unsoundness  arising.  In  the 
Watson  case,  an  old  man  of  86  was  held  to  be  competent  to 
make  a  will,  and  cases  are  on  record  of  wills  made  at  ninety  or 
over  which  stood.  The  law  that  "if  a  man  in  his  old  age  be- 
comes a  very  child  again  in  his  understanding,  and  is  become 
so  forgetful  that  he  knows  not  his  own  name,  he  is  then  no 
more  fit  to  make  a  testament  than  a  natural  fool,  a  child  or  a 
lunatic."     (Browne). 

In  the  case  of  Harwood  vs.  Baker  in  which  a  will  was  made 
in  favor  of  a  second  wife  to  the  exclusion  of  the  testator's  fami- 
ly, the  testator  being  in  a  condition  of  mental  feebleness  from 
disease,  the  charge  of  Erskine  was  to  this  effect. 

"  Their  lordships  are  of  opinion  that  in  order  to  constitute 
a  sound  disposing  mind,  a  testator  must  not  only  be  able  to 
understand  that  he  has  by  his  will  given  the  whole  of  his  prop- 
erty to  one  object  of  his  regard,  but  he  must  also  have  capacity 
to  comprehend  tlie  extent  of  his  proj^erty  and  the  nature  of  the 
claims  of  others  whom  by  his  will  he  is  excluding  from  all  par- 
ticipation in  that  property,  and  that  the  protection  of  the  law 
is  in  no  cases  more  needed  than  it  is  in  those  where  the  mind 
has  been  too  much  enfeebled  to  comprehend  more  objects 
than  one,  and  more  especially  where  that  object  may  be  so  forced 
upon  the  attention  of  the  invalid  as  to  shut  out  all  others  that 
might  require  consideration." 

Tlie  Test  of  a  Disposing  Mind. — With  regard  to  the 
proof  of  a  disposing  mind  an  .English  Judge  (Brett)  said  "  that 
it  was  not  sufficient  for  the  testator  to  understand  merely  that 
he  was  making  a  will,  but  they  (the  jury)  had  to  say  whether 
at  the  time  the  will  was  made,  the  testator  had  sufficient  intelli- 
gence to  understand  substantially  the  state  of  his  family  and  of 
his  affairs,  and  the  disposition  of  his  property  as  made  by  the 
will,  and  if  he  had  sufficient  power  of  mind  to  intend  to  make 
such  disposition."  

Case  I. — Alleged  Impairment  cy  Reason  of  Old  Age — 
Will  Sustained. — Matter  of  Lucy  H.  Eddy,  32  N.  J.,  Eq., 
701. 

Lucy  H.  Eddy  died  in  Rahway,  in  1879.  She  was  a  daugh- 
ter of  the  late  Thomas  Eddy,  of  New  York,  who  was  distin- 
guished for  his  public  spirit  and  philanthropy,  and  inherited 
from  him  his  strong  mental  qualities  and  convictions  of  duty. 
She  left  a  will  dated  Jan.  15,  1875,  and  a  codicil  dated  Sept.  5, 
1S76.     This  will  was  contested  in  the  Prerogative  Court,  on  the 


THE    LEGAL    RELATIONS    OF    INSANITY.  8l 

ground  of  lack  of  testamentary  capacity.  Deceased  was  83 
years  old  at  the  time  she  executed  the  will,  and  none  of  the  wit- 
nesses for  contestants  testified  that  deceased  was  of  unsound 
mind,  but  only  averred  to  the  weakness  of  memory  regarding 
recent  occurrences,  which  might  be  expected  in  a  person  of 
such  advanced  age,  and  some  would  not  even  say  that  she  was 
unfit  to  make  a  will.  On  the  other  hand  it  was  shown  that  she 
read  the  classics  and  histories,  and  would  excite  admiration  by 
her  able  discussion  of  them  ;  that  she  seemed  to  remember  old 
events  ;  she  answered  questions  intelligently  ;  knew  what  she 
was  doing  ;  that  she  knew  who  her  relations  were  ;  that  she 
used  an  old  will  as  the  basis  of  her  will  of  1875  and  made  all 
the  necessary  memoranda  thereon  herself. 

Another  point  advanced  by  contestants  was  the  confidence 
reposed  by  deceased  in  her  attorneys,  and  her  indifference  to 
the  fact  that  much  more  money  iiad  been  expended  on  the 
building  of  a  house  for  her  than  was  at  first  contemplated,  and 
it  was  claimed  that  this  was  evidence  of  the  want  of  that  capa- 
city requisite  to  the  making  of  a  will,  but  it  was  held  that  this 
merely  amounted  to  natural  confidence  in  capable  business 
men.  Held  also,  that  mere  forgetfulness  of  recent  events  is  no 
evidence  of  incapacity  to  make  a  will. 

The  will  was  therefore  admitted  to  probate. 

Testamentary  capacity  is  destroyed  then  by  actual  weakness  of 
mind,  as  v;ell  as  by  insane  delusion  ;  or  by  any  thing  that  will 
weaken  the  individual's  memory  and  judgment  and  volition  in 
relation  to  the  disposal  of  his  property,  or  the  objects  of  his 
bounty.  So  far  as  the  delusions  do  not  interfere  with  the  ac- 
tual disposition  of  the  property  it  has  been  held  that  this  will 
may  be  valid.  Such  was  the  ruling  of  Cockburn  in  the  case  of 
Banks  vs.  Goodfellow. 

"  No  doubt  when  the  fact  that  th^  testator  had  been  subject 
to  any  insane  delusion  is  established,  a  will  should  be  regarded 
with  great  distrust,  and  every  presumption  should  in  the  first 
instance  be  made  against  it.  When  insane  delusions  have  once 
been  shown  to  have  existed,  it  may  be  difficult  to  say  whether 
the  mental  disorder  may  not  possibly  have  extended  beyond  the 
particular  form  or  instance  in  which  it  has  manifested  itself. 
It  may  be  equally  difficult  to  say  how  far  the  delusion  may  not 
have  influenced  the  testator  in  the  particular  disposal  of  his 
property,  and  the  presumption  against  a  will  made  under  such 
circumstances  become  additionally  strong  when  the  will  is,  to 
use  the  term  of  the  civilian  an  insufficient  one,  that  is  to  say, 
one  in  which  natural  affection  and  the  claims  of  near  relation- 


Sz  MEDICAL    JURISPRUDENCE. 

ship  have  been  disregarded.  But  when  in  the  result,  the 
jury  are  satisfied  that  the  delusions  have  not  affected  the  general 
faculties  of  the  mind  and  can  have  no  effect  upon  the  will, 
we  see  no  sufficient  reason  why  the  testator  should  be  held  to 
have  lost  his  right  to  make  a  will,  or  why  a  will  made  under 
such  circumstances  should  not  be  upheld." 

The  celebrated  Jumel  will  case  was  one  in  which  the  ques- 
tion of  delusion  arose.  Madame  Jumel  died  some  years  ago 
leaving  a  large  and  valuable  estate  to  different  religious  and 
charitable  institutions,  cutting  off  her  family.  It  was  shown 
that  the  testatrix,  who  was  a  very  old  woman  when  the  will  was 
made,  was  peculiar  and  crotchety,  and  that  she  labored  under 
the  delusion,  among  others,  that  she  was  the  victim  of  a  plot — 
that  her  relatives  had  attempted  to  poison  her,  and  so  deep- 
seated  was  her  belief  that  she  refused  all  food  until  she  pro- 
cured it  herself.  The  case  was  tried  in  the  Supreme  Court  of 
New  York  in  1866,  and  the  Court  took  the  position  that  if  she 
was  insane  because  of  these  delusions,  she  was  incompetent  to 
make  a  will. 

A  case  not  so  clear  as  the  above  is  referred  to  by  Dr.  Lee  in 
an  able  paper.  Such  examples  are  very  common  in  the  courts, 
but  it  frequently  transpires  that  the  original  hatred  of  the  tes- 
tator is  Avell  founded. 

"George  Moore,  of  Kentucky,  made  his  will  in  April,  1822, 
and  shortly  afterward  died.  The  validity  of  the  will  was  dis- 
puted on  the  ground  of  unsoundness  of  mind  in  the  testator. 
It  was  shown  that,  about  twenty-four  years  before  his  death  he 
had  a  dangerous  fever,  during  which  he  contracted  a  strong 
hatred  against  his  brothers,  who  he  imagined  intended  to  injure 
or  destroy  him,  although  they  had  attended  him  through  his 
illness,  and  never  gave  any  cause  for  his  suspicion.  This  an- 
tipathy continued  until  the  day  of  his  death,  with  a  single  ex- 
ception, when  he  made  a  will  in  their  favor,  which  he  subse- 
quently canceled.  The  Court,  in  its  decision,  said  :  '  that  he 
cannot  be  accounted  a  free  agent  in  making  liis  will,  so  far  as 
his  relatives  are  concerned,  although  free  as  to  the  rest  of  the 
world.  But,  however  free  he  may  have  been  as  to  other  ob- 
jects, the  conclusion  is  irresistible  that  the  peculiar  defect  of 
intellect  did  influence  his  acts  in  making  his  will,  and  for  this 
cause  it  ought  not  to  be  sustained.'  " — (Little's  Reports,  371). 


THE    LEGAL    RELATIONS    OF    INSANITY.  83 


Case  II. — General  Competency,  with  the  Existence  of 
A  Delusion  in  Regard  to  Son — Will  not  Admitted  to 
Probate. 

Merrill      ) 

vs.  )•      5  Redfield,  220. 

Rolston,    ) 

(Will  of  Caroline  A.  Merrill.) 

Deceased  made  a  will  in  1856,  liequeathing  all  her  property 
to  G.,  her  adopted  son,  in  reversion.  G.  subsequently  married 
against  the  wishes  of  deceased,  which  led  to  an  estrangement 
between  them,  and  deceased  thereafter  manifested  an  intense 
hatred  for  him  ;  mutilated  her  will  and  his  portrait,  and  in 
various  other  ways  manifested  her  displeasure  ;  made  vulgar 
charges  against  himself  and  his  wife  ;  and  subsequently  (in 
187 1 )  made  the  present  will  in  which  she  ignored  G. 

Upward  of  20  different  witnesses  testified  to  the  rational 
conduct,  intelligence  and  conversation  of  deceased.  She 
traveled  from  place  to  place,  crossing  the  ocean,  paid  her  own 
bills,  kept  a  diary  of  her  travels  and  books  of  account,  wrote 
various  letters  evincing  judgment,  coherence  and  discretioft, 
and  showing  no  evidence  of  mental  weakness. 

Held,  that  while  no  reasonable  doubt  arose  of  her  general 
capacity  to  execute  the  will,  the  instrument  propounded  should 
be  refused  probate  because  it  was  executed  by  decedent  when 
laboring  under  an  insane  delusion,  the  same  being  the  direct 
offspring  of  such  delusion.     See  Miller  vs.  White,  5  Redfield, 


Case    III. — Alteration   of    Will    Under   Influence  of 
Delusion —  Codicil  Refused  Probate. 
Miller    ^ 

vs        V      5  Redfield,  320. 
White,   ) 

(Will  of  Anna  M.  White.) 

Testatrix  executed  a  will  in  1877,  containing  a  legacy  to  a 
niece.  In  1878  her  mind  began  to  fail.  She  became  untidy, 
mean,  vulgar,  averse  to  company,  abusive  and  suspicious.  She 
conceived  a  great  dislike  for  her  niece,  and  frequently  accused 
her  of  dishonesty.  She  also  had  delusions,  believing  that  she 
saw  persons  who  were  dead  or  not  present.     In  March,  1878, 


84  MEDICAL    JURISPRUDENCE. 

she  executed  a  codicil  to  her  will  revoking  the  legacies  to  her 
niece. 

Held,  that  while  the  testatrix  may  not  have  been  of  unsound 
mind  she  was  the  victim  of  an  insane  delusion  at  the  time  of 
making  the  codicil,  and  that  the  codicil  must  be  refused  probate. 


Case  IV. — Imbecility — Will  not  Admitted  to  Probate. 

Townsend 

vs.  \      5  Redfield,  93. 


Bogart, 


(Will  of  Mary  E.  Hatfield.) 


Testatrix  could  not  read  or  write  although  she  attended 
school  for  three  years  ;  could  not  count  more  tlian  ten  ;  could 
not  tell  time  by  clock  ;  could  not  recall  any  ordinary  event  in 
her  life  ;  could  not  comprehend  value  of  money  or  property  ; 
would  make  presents  of  pictures  cut  from  magazines,  and  old 
pieces  of  calico  and  silk  ;  and  was  easily  lost  in  familiar  streets. 
She  attended  her  own  housework  and  was  very  devout  and 
regular  in  her  attendance  at  church.  She  had  a  sister  in  an 
insane  asylum  and  was  herself  adjudged  insane  two  years  after 
making  her  will. 

Several  witnesses  testified  that  from  impressions  received 
while  conversing  with  deceased  they  believed  her  to  be  of 
sound  mind  ;  but  beyond  the  circumstances  attending  the 
signing  of  the  will  no  incidents  of  any  import  were  adduced  in 
support  of  their  belief. 

Held,  that  decedent  was  not  of  sound  and  disposing  mind 
when  she  executed  the  will. 


The  question  of  so-called  partial  insanity  arises  in  relation 
to  the  will  of  a  i)erson  of  whose  insanity  no  evidence  can  be 
brought  forward  except  the  fact  of  a  particular  delusion. 

Wharton  and  Stille  allude  to  the  case  of  an  eccentric  old 
woman  who  made  a  will  disinheriting  her  brotlier  who  she  in- 
sanely believed  had  joined  the  Catholics,  to  whom  she  had  a 
strong  aversion.  The  decision  of  Lord  Brougham  in  this  case 
has  a  healthy  tone  not  often  found  in  these  days.  He  ex- 
pressed his  disbelief  in  partial  insanity  and  held  that  the  mind 
was  "  one  and  indivisible,  and  if  unsound  on  one  subject,  pro- 
vided that  unsoundness  is  at  all  times  existing  on  that  subject, 
it  is  quite  erroneous  to  suppose  such  a  mind  really  sound  on 
oilier  subjects  ;  it  is  sound  only  in  appearance." 


THE    LEGAL    RELATIONS    OF    INSANITY.  S5 


Case  V. — Existing    Delusions     not    Interfering    with 
Capacity — Will  Admitted  to  Probate. 

Dickie        ) 
vs.  \      5  Redfield's  R.,  284. 

VanVleck,    ) 

(Will  of  Patrick  Dickie.) 

The  testator  executed  the  will  in  controversy  in  187 1,  A 
few  days  before  its  execution  testator  called  upon  the  attorney 
who  drew  the  will,  and  who  knew  nothing  of  his  financial  or 
family  affairs,  and  gave  him  instructions  with  intelligence  and 
coherence  as  to  its  provisions.  In  1874,  the  testator  was  ad- 
judged a  lunatic.  It  was  attempted  to  prove  by  the  opinions 
of  medical  experts,  based  upon  certain  occasional  acts  and 
delusions  of  the  testator,  that  he  was  not  of  sound  mind  before 
and  at  the  time  of  the  execution  of  the  will.  Among  the  evi- 
dence relied  on  to  support  these  opinions,  was  the  testimony 
of  a  servant  to  whom  the  testator  stated  in  1870,  *'  that  his 
housekeeper  was  an  English  spy,  and  her  numerous  boxes 
filled  with  gunpowder,"  and  that  he  ordered  a  barrel  of  flour 
sent  from  the  basement  because  it  contained  a  dead  body. 
There  was  much  conflicting  testimony  regarding  the  conduct 
of  deceased,  both  before  and  after  he  executed  the  will ;  for 
while  contestant's  witnesses  testified  to  various  strange  sayings 
and  doings  of  decedent,  several  of  proponent's  witnesses  with 
whom  deceased  had  had  frequent  dealings  for  years,  stated 
that  they  observed  nothing  unusual  or  extraordinary  in  his 
conduct  during  that  time. 

Held,  that  these  occasional  acts  were  not  sufficient  proof 
that  the  testator  was  of  unsound  mind  at  the  time  of  the  exe- 
cution of  the  will. 


Case    VI. — Alleged   Insane    Delusions    in    Regard    to 
•  Children — Will  Admitted. 

Leslie      ) 

vs.         (       ^5  ^'  Y.  Weekly  Digest,  56. 
Leslie,     ) 

Testator  executed  a  will  in  December,  1879,  and  died  Janu- 
ary 8,  1880.  He  bequeathed  all  his  property  to  his  wife,  and 
ignored  his  children,  who  contested  the  will.  Testator  received 
an  injury  to  his  head  twenty  years  before  his  death.     Contest- 


Hb  MEDICAL    JURISPRUDENCE. 

ants  claimed  that  he  had  been  induced  to  disinherit  them 
through  insane  delusions  ;  that  considerable  rivalry  in  business 
had  existed  between  himself  and  his  sons  ;  that  they  had 
assisted  in  certain  lawsuits  against  him  ;  that  testator  believed 
from  these  circumstances  that  his  sons  were  unfriendly  to  him 
and  his  interests.  That  testator  had  lost  all  affection  for  one 
of  his  sons  because  he  refused  to  visit  him  when  ill. 

On  the  other  hand  it  was  shown  that  he  had  successfully 
and  intelligently  conducted  a  large  business  for  over  twenty 
years,  and  none  observed  in  his  conduct  any  word  or  act  to 
warrant  the  belief  that  his  mind  was  impaired. 

Held,  that  to  constitute  an  insane  delusion,  something  more 
than  an  unwarranted  conclusion  from  existing  facts  must  be 
shown. 


Case  VII. — Alleged  Insanity  of  Testator  not  Proven 
— Fancied  Resentment  not  amounting  to  Insane 
Delusion — Will  Admitted. 

American  Bible  Society  ) 

vs.  \      12  N.  Y.  Weekly  Digest,  213. 

Stover,  ) 

Deceased  was  a  man  of  peculiar  temperament,  of  poor 
health,  of  weak  intellect,  miserly,  and  wandering  habits.  He 
became  angered  toward  his  family  because  of  a  fancied  slight, 
and  manifested  his  resentment  to  an  exaggerated  degree  upon 
every  occasion.  It  was  conceded  that  he  was  not  affected 
with  any  form  of  general  insanity. 

Held,  that  this  was  not  proof  absolute  of  an,  insane  delusion. 


The  Bristed  will  case  was  one  in  which  no  evidence  of  in- 
competency was  proven,  although  testimony  was  adduced  re- 
gardfng  the  testator's  insanity  previous  to  the  making  of  the 
will. 
Case  VIII. 

In  Bristed  ) 

vs.  \    5  Redfield's  Surrogate's  Court  Repts.  529. 

Weeks         I 

(Will  of  John  J.  A.  Bristed.) 

The  testator,  who  died  in  1880,  executed  a  will  in  1871.     In 

February,   1873,   he  was  examined  at    Paris  by  Dr.  Blanche, 

who  caused  him  to  be  conveyed  to  a  lunatic  asylum,  where  he 

remained  under  Dr.  B.'s  observation  for  a  week.     Dr.  B.  states 


TriE    LEGAL    RELATIONS   OF    INSANITY.  by 

that  in  his  opinion  the  decedent  "was  born  under  bad  condi- 
tions of  cerebral  heredity,  and  had  never  been,  even  in  his 
infancy,  in  a  well  balanced  nervous  condition,  nor  of  a  thor- 
oughly sound  judgment."  In  support  of  this  opinion  he  says. 
"From  his  infancy,  John  J.  A.  Bristed  was  subject  to  nervous 
crises,  during  which  he  uttered  cries.  He  was  never  able  to 
fix  his  attention  continuously.  He  could  not  remember  what 
he  learned."  *  *  * 

Another  witness  (Mrs.  Caroline  Carson),  a  friend  of  the 
Bristed  family,  testified  that  the  decedent  was  naturally  good 
natured,  and  she  could  not  believe  he  would  have  been  guilty 
of  the  acts  of  violence  he  had  committed,  if  he  had  been  in  his 
right  mind.  That  "  as  a  child  he  seemed  gentle  and  sweet- 
tempered  ;  but  as  he  grew  older  he  seemed  to  be  bereft  of 
reason.  He  would  shriek  like  a  wild  Indian,  and  rush  out  of 
tlie  house  like  a  madman  without  any  cause.  He  would  play 
the  piano  for  hours  by  day,  and  then  get  up  in  the  dead  of 
night  and  go  on  playing.  *  *  On  returning  home  at  night, 
instead  of  ringing  the  bell,  he  would  throw  stones  at  the  house." 
She  concludes  :  '' I  saw  him  in  1877,  when  he  was  acknowl- 
edged a  lunatic.  His  talk  was  precisely  the  same  I  had  always 
known  it." 

The  Court  says,  after  reviewing  this  testimony  :  "  On  the 
whole,  therefore,  I  do  not  feel  justified  in  attaching  much 
importance  to  Mrs.  Carson's  testimony  which  relates  to  the 
testator's  mental  capacity." 

Other  witnesses  testified  that  the  testator  was  very  nervous 
and  would  get  into  a  passion  about  very  trivial  matters  ;  also, 
that  he  was  "  a  little  forgetful  at  times." 

With  -regard  to  the  plea  of  hereditary  insanity,  the  Court 
says  :  "  The  circumstance  that  certain  collateral  relatives  of 
decedent,  the  descendants  of  his  great-grandfather,  have  been 
afflicted  with  mental  disease,  throws  little  light  upon  the  ques- 
tion— at  what  period  of  his  life  he  first  became  its  victim. 
Evidence  that  he  had  an  hereditary  tendency  to  insanity  does 
not  establish,  of  course,  that  such  insanity  was  probably  con- 
genital, or  that  it  declared  itself  at  any  particular  stage  of  his 
career.  And  besides,  the  evidence  does  not  disclose  the  exist- 
ence of  insanity  among  his  immediate  family  or  his  lineal 
ancestry  on  either  his  father's  or  mother's  side." 

Held,  that  at  the  time  of  the  execution  of  the  will,  the  dece- 
dent "  w?,s  of  sound  and  disposing  mind  and  memory." 

Note. — Beyond  the  statement  that  some  twenty  witnesses 
stated   that  they  saw  nothing  irrational  in  the  conduct  of  de- 


66  MEDICAL   JURISPRUDENCE. 

ceased  at  the  time  of  his  departure  for  Europe  in  1871,  there 
is  no  further  reference  to  the  testimony  in  support  of  his  sanity 
in  the  report  of  this  case.  The  opinion  of  the  Surrogate  seems 
to  be  based  mainly  on  the  failure  of  contestants  to  prove  mental 
unsoundness  of  deceased. 

I  examined  Mr.  Bristed  during  the  last  year  or  two  of  his 
life,  and  though  at  the  time  he  suffered  from  a  light  grade  of 
chronic  mania,  there  was  no  reason  to  believe  he  did  not  pos- 
sess testamentary  capacity  ;  in  fact,  his  will  was  an  exceedingly 
just  one,  the  principal  legatee  being  a  sister  who  had  not  fared 
as  well  as  he  in  the  original  division  of  the  property.  The  con- 
testants were  his  step- mother  and  an  infant  half-brother. 


Case  IX. — Insanity  Extending  over  a  Long  Period,  no 
Evidence  of  Delusions  Affecting  Testamentary 
Capacity — Will  Declared  Valid. 

Kingsbury  ) 

vs.  y      32  Louisiana  Annual  Reports  1055. 

Whitaker,  ) 

G.  M.  Bowditch  died  August  i,  1877,  leaving  a  will  dated 
June  24,  1876,  bequeathing  all  his  properly  to  his  sister,  Mary 
Ann  Fiske.  He  had  been  a  successful  business  man  and  had 
accumulated  some  property,  but  during  the  late  war  and  the 
corrupt  administrations  which  followed  it,  he  met  with  serious 
losses  which,  as  he  himself  says,  rendered  him  "  irascible,  sad 
and  despondent."  He  became  subject  to  violent  paroxysms 
of  rage  which  rendered  him  for  the  time  being  insane,  and  he 
was  frequently  confined  in  jail  and  in  asylums.  His  relatives  fin- 
ally procured  his  confinement  in  an  asylum  in  Massachusetts, 
from  which  he  was  released  in  1874.  Thereafter  he  manifested  an 
intense  dislike  for  the  said  relatives,  particularly  his  brother-in- 
law.  Rev.  Mr.  Dowse,  whom  he  styled  "  an  orthodox  thief  ;  "  but 
it  appeared  that  his  mother  was  living  with  said  Dowse  and  that 
he  was  paying  $3.00  a  week  for  her  board,  and  that  Dowse  had 
demanded  more  as  she  was  growing  old  and  troublesome.  It 
appears  that  when  under  one  of  his  insane  attacks  he  would 
gather  from  the  streets  cigar  stumps  and  other  refuse,  and  pre- 
serve them  as  valuables.  His  letters  written  between  1864  and 
1877,  both  before  and  after  his  temporary  fits  of  insanity,  prove 
him  to  have  been  a  man  of  great  intelligence  and  learning, 
and  a  close  observer  of  men.  There  was  no  direct  proof  that 
he  was  insane  when  he  executed  the  will  ;  on  the  contrary  it  is 
shown  that  he  drew  the  will  himself,  and  both  the  witnesses 


THE    LEGAL    RELATIONS   OF    INSANITY,  09 

who  attested  it  say  that  he  spoke  very  rationally  on  that  occa- 
sion. There  is  also  a  letter  written  by  him  July  14,  1876,  in 
which  he  speaks  of  the  proceedings  instituted  to  have  him  de- 
clared insane  and  of  the  plans  he  has  formed  to  resist  them. 
This  letter  is  very  coherent  and  full  of  sound  reasoning, 

On  appeal,  the  Supreme   Court   declared  deceased  to  have 
been  sane  when  he  executed  the  will. 


Case  X. — Alleged  Delusions  in    Regard  to    Sons,  not 

PROVEN    HOWEVER WiLL    SUSTAINED. 

(Will  of  Ebenezer  W.  Cole,  49  Wisconsin  Reports  179.) 
Ebenezer  W.  Cole  executed  his  will  January  i,  1872.  He 
died  Nov.  4,  1878  aged  78  years.  He  left  two  children,  one 
(Elliott  G.)  by  his  first  wife,  and  one  (Rinaldo)  by  his  second 
wife,  from  whom  he  was  divorced  in  1869,  and  a  widow  whom 
he  married  in  1870.  The  will  which  left  the  bulk  of  his  property 
to  his  widow  was  contested  by  the  sons  on  the  ground  of  insanity. 
It  was  shown  that  about  1863  deceased  conceived  the  idea  that 
his  wife  was  untrue  and  that  Rinaldo  was  not  his  son.  No 
ground  for  this  belief  was  shown.  In  1864  deceased  and  his 
wife  separated,  and  in  1869  he  procured  a  divorce  under  the 
Wisconsin  statue,  making  five  years'  separation  ground  therefore. 
Deceased  was  in  the  habit  of  taking  large  quantities  of  mor- 
phine and  chloral  daily,  but  ceased  using  the  chloral  a  few  days 
before  he  executed  the  will,  and  it  was  claimed  that  his  mind 
was  seriously  affected  thereby.  No  other  evidence  was  given 
to  prove  testator's  insanity. 

In  sustaining  the  will  the  Supreme  Court  held  that  as  there 
was  no  proof  that  deceased  was  laboring  under  the  delusion  re- 
garding his  son  Rinaldo  at  the  time  of  its  execution,  the  will 
was  valid. 


Case  XI, — Alleged  Insanity  (Probably  Bad  Temper  and 
Hysteria) — Will  Admitted  to  Probate. 

Coit.  ) 

vs.  )■         77  N.  Y.  533. 

Patch en,       ) 

Emily  Coit  died  in  June  1875  aged  67  years.  Her  will  was 
executed  Aug.  i,  1874.  She  left  real  estate  valued  at  $150,000. 
The  will  was  contested  on  the  ground  that  testator  labored 
under  delusions  regarding  her  husband  and  some  of  her  chil- 
dren ;    that  she  believed  her  husband  had  held  improper  rela- 


po  MEDICAL    JURISPRUDENCE. 

tions  with  other  women  ;  that  she  showed  no  affection  for  some 
of  her  family  ;  that  her  daughter,  Mrs.  Grey,  was  ill-treated  ''y 
the  rest  of  the  family  (because  she  had  sympathized  with  c  e 
ceased  in  a  divorce  suit  between  her  and  her  husband,  and  had 
stood  by  her  in  all  her  domestic  troubles)  ;  and  that  she  (Mrs. 
Grey)  was  in  danger  of  coming  to  want,  that  these  delusions 
were  the  result  of  illness  in  1868.  It  was  shown  that  she  was 
jealous  of  her  husband  and  once  struck  him  for  looking  ai 
another  woman  ;  that  they  often  quarreled,  and  lived  apan;  ■sev- 
eral times  ;  that  at  one  time  a  divorce  suit  was  pending  between 
them.  That  her  son  had  assaulted  her  and  been  convicted 
therefor.  It  was  also  shown  that  after  her  illness  in  1868  and 
up  to  the  time  of  her  last  illness  she  continued  to  manage  her 
estate  with  intelligence  and  prudence,  as  she  had  done  thereto- 
fore. 

The  Surrogate  made  a  decree  admitting  the  will  to  probate, 
and  on  appeal  both  the  Supreme  Court  and  Court  of  Appeals 
affirmed  this  decision. 

Eccentricity  in  Relation  to  Testamentary  Capacity. 

— Mere  disproportion  in  the  division  of  property  or  eccentricity 
are  not  necessarily  evidence  of  testamentary  incapacity,  and 
although  the  law  is  very  careful  in  regard  to  the  question  of  un- 
due influence,  great  care  should  be  taken  to  distinguish  between 
cases  in  which  the  individual  defers  with  perfect  propriety  to 
the  suggestions  of  intelligent  and  life-long  friends  instead  of  bad 
children  who  never  have  shown  any  filial  respect  or  interest  in 
the  testator  until  the  question  of  the  division  of  property  is 
raised.  When,  on  the  other  hand,  a  kind  father,  whose  rela- 
tions with  his  children  are  of  the  pleasantest  kind,  becomes, 
during  the  latter  years  of  life,  morose,  irritable,  and  shows  un- 
warrantable dislike,  neglect,  with  moral  and  intellectual  weak- 
ness grave  doubts  arise. 

Eccentricity  should  not  be  misunderstood  and  looked  upon 
as  disease,  nor  should  superstitious  belief,  or  the  striking  ex- 
aggeration of  character  of  old  age  we  sometimes  find,  which, 
however,  are  perfectly  consistent  with  mental  integrity.  In 
the  Bonnard  will  case  the  testator,  an  old  man,  left  a 
large  sum  of  money  to  the  Society  for  the  Prevention 
of  Cruelty  to  Animals,  and  a  clause  was  inserted  pro- 
viding for  the  care  of  certain  dumb  beasts.  At  first  this 
was  looked  upon  as  a  positive  sign  of  mental  unsoundness, 
but  when  it  transpired  that  the  aged  testator  was  a  believer  in 
metempsychosis,  the  rational  cliaracter  of  the  act  was  manifest. 


THE    LEGAL    RELATIONS    OF    INSANTIV.  9I 

The  belief  in  spiritualism  or  Swedenborgianisni  or  any  other 
ism  which,  perhaps,  leads  the  testator  to  leave  a  legacy  to  some 
religious  body,  no  matter  how  irregular,  is  not  necessarily  in- 
sanity and  should  not  be  so  considered. 

In  courts  of  law  it  is  often  contended  that  because  the  indi- 
vidual wears  certain  loud  colors  and  ungainly,  conspicuous 
dress,  or  because  he  eats,  or  drinks,  or  walks,  or  sleeps  in  an  un- 
usual way,  he  is  of  unsound  mind.  Not  only  life-long  pecu- 
liarities, but  personal  traits  which  may  be  the  offspring  of  igno- 
rance or  vanity  or  even  vulgarity,  may  sometimes  be  sufficient 
in  the  eyes  of  snobbish  or  ungrateful  children  to  stamp  their 
progenitor  as  of  unsound  mind. 

Case  XII. — Religious  Eccentricity — Will  Admitted  to 

Probate. 

Hartwell      ) 

V.  (4  Redfield,  389. 

McMaster,     ) 

Deceased  executed  his  will  on  September  25,  1880,  and  died 
October  i,  1880,  aged  72  years,  leaving  no  children.  He  had 
been  in  business  in  New  York  city,  had  taught  school,  preached, 
and  had  some  knowledge  of  electricity.  On  behalf  of  contes- 
tants it  was  claimed  that  testator  lacked  testamentary  capacity, 
and  it  was  shown  that  he  did  not  believe  in  the  doctrine  of  the 
"  Real  Presence"  or  transubstantiation,  nor  in  the  necessity  of 
baptism  in  infancy.  That  he  lived  alone  and  locked  himself  in 
during  his  last  illness  ;  that  he  had  once  disturbed  a  religious 
meeting  by  abusing  the  minister  ;  that  he  wished  to  attend  a 
public  school  as  a  pupil  ;  that  when  over  60  years  old  he  fell  in 
love  with  a  girl  of  12, 

Held  that  this  was  not  sufficient  to  prove  that  testator  was 
insane  or  lacked  testamentary  capacity. 

The  question  of  the  effects  of  bodily  disease  upon  the  mind 
is    a  favorite  one  sometimes,  though  several    important   cases 
have   been   decided   adversely  when  such  an   issue  has  been 
raised.     A  familiar  case  is  that  of 
La  Bau         1 

V,  i      3  Redfield,  384. 

Vanderbilt,       ) 

(Will  of  Cornelius  Vanderbilt.) 


Case  XIII.  

The  deceased  executed  his  will  in  1875,  bequeathing  most  of 


92  MEDICAL     lURISPRUDENCE, 

his  property  to  his  son  Wm.  H.  The  will  was  contested  by 
his  daughter,  Mary  A.  La  Bau,  on  the  ground,  among  others, 
that  deceased  was  not  of  sound  mind  and  memory.  After  his 
death  an  autopsy  was  held  and  revealed  the  fact  that  deceased 
was  afflicted  with  several  chronic  and  painful  diseases  which 
most  of  the  medical  experts  agreed  had  a  tendency  to  affect 
the  mind.  It  was  testified  that  deceased  had  stated  that  he  was 
the  railroad  king  of  America  ;  he  had  also  said  that  his  memory 
was  failing  him  ;  that  deceased  was  ambitious,  excitable, 
violent,  and  irritable  ;  that  his  mind  vacillated  for  some  time 
before  he  made  his  will  as  to  whether  he  would  distribute  his 
estate  equally  among  his  children  as  he  had  expressed  an  in- 
tention of  doing  years  before,  or  whether  he  sliould  bequeath  it 
as  the  present  will  provided  ;  he  was  very  capricious  in  his  likes 
and  dislikes  of  his  children  ;  that  he  was  credulous,  suspicious, 
talkative,  vain  ;  that  he  contemplated  a  monument  loo  feet 
higher  than  any  other  ;  he  believed  he  received  spiritual  com- 
munications regarding  the  terms  of  his  will  and  business  affairs. 

On  the  other  hand  many  eminent  persons  who  had  known 
him  for  years,  and  transacted  business  with  him,  testified  to  his 
intelligence  and  good  judgment  down  to  his  last  illness.  Re- 
garding the  autopsy,  it  was  shown  that  the  brain  of  deceased 
had  not  been  examined,  and  it  was  claimed  that  the  surmises 
as  to  the  probable  effect  of  the  diseases  upon  the  mind  of  de- 
ceased. 

Held  that  there  Avas  no  evidence  that  deceased  was  of  un- 
sound mind  and  memory. 


Case  XIV. — Will  of  Alleged  "  Kleptomaniac"  of  Eccen- 
tric Habits  no  Evidence  of  Insanity — Will  Sus- 
tained. 

Matter  of  Will  of  I  -nt    t   -c      •..    -o 

T  T       ■         r    ^■^  N.  T.  Equity  Reports,  210. 

James  Lewis,      j     •^'J        j        i-     j        -i        >      y 

Joseph  L.  Lewis  died  in  Hoboken,  March  5,  1877,  aged  86 
years,  leaving  considerable  property,  .  On  October  i,  1873,  he 
executed  his  will,  which,  after  making  several  bequests,  directed 
that  the  remainder  of  his  estate  be  applied  in  reducing  the  na- 
tional debt  of  the  United  States  incurred  during  the  rebellion 
of  1861.  The  attorney  who  drew  the  will  stated  that  there  was 
much  care  and  consideration  given  to  the  will  by  the  testator, 
he  himself  making  the  memoranda  for  its  preparation,  and 
that  a  draft  of  it  was  made  and  subniitted  to  him  before  it  was 


THE    LEGAL    RELATIONS    OF    INSANlXy.  93 

executed  ;  that  he  was  very  solicitous  about  some  stocks  and 
bonds  deposited  in  New  York  city,  and  wished  the  will  drawn 
so  that  they  would  be  disposed  of  by  it ;  that  his  mind  was  per- 
fectly sound  and  his  memory  good.  It  was  claimed,  however, 
that  he  was  a  kleptomaniac  ;  would  pilfer  articles  of  small 
value  ;  toward  the  close  of  his  life  he  became  miserly  ;  used 
profane  language  ;  was  unclean  and  careless  in  his  personal  ap- 
pearance. It  was  proven,  however,  that  in  his  business  trans- 
actions he  was,  up  to  the  time  of  his  death,  shrewd,  prudent ; 
that  he  never  manifested  any  symptoms  of  an  unsound  mind  ; 
was  suspicious  ;  had  an  iron  will  ;  of  strong  attachments  ;  of 
strong  antipathies  ;  always  made  good  investments. 

The  Prerogative  Court,  in  admitting  the  will  to  probate,  held 
that  there  was  no  evidence  of  unsound  mind.  His  bequest  to 
the  United  States  was  evidence  of  a  lofty  attachment  and  fidelity 
to  his  country — not  of  his  disordered  imagination. 


Case   XV. — Incompetency  to  make   a  Will  Alleged  to 

BE    due    to    BrIGHT's    DISEASE — WiLL    SUSTAINED. 

Mairs  ) 

vs.  [•  3  Redfield,  i8i. 

Freeman,  ) 

(Will  of  James  Mairs.) 

The  testator  in  this  case  had  in  his  will  mistaken  the  order 
of  birth  of  two  of  his  children  ;  had  misstated  his  own  age,  and 
had  neglected  certain  grandchildren  in  his  will.  He  had  been 
suffering  from  Bright's  disease  in  connection  with  other 
diseases  for  two  years  previous  to  his  death,  and  it  was  claimed 
that  his  intellect  had  been  impaired  thereby.  There  was 
no  direct  testimony  of  the  mental  unsoundness  of  deceased, 
but  there  was  conflicting  testimony  by  medical  doctors  as  to 
the  effect  of  Bright's  disease,  etc.,  on  the  mind. 

Held,  that  deceased  was  of  sound  and  disposing  mind. 


Case  XVI. — Testamentary  Capacity  Alleged  to  be 
Destroyed  by  Insanity  resulting  from  Cancer — 
Will  Sustained. 

Fraser  ) 

vs.  >         42  Michigan  Reports,  206. 

Jennison,         ) 
This  was  a  contest  of  the  will  of  the  late  Alexander  D.  Fraser, 
of  Detroit,  a  leading  member  of  the  Michigan  bar.     The  will 
was  dated  May  17,  1877.     The  evidence  showed  that  deceased 


94  MEDICAL    JURISPRUDENCE. 

was  over  eighty  years  old  and  had  been  suffering  for  over 
twenty  years  trom  a  cancer  on  the  nose  which  ultimately  con- 
sumed the  flesh  on  one  side  of  his  face  and  also  his  eye,  and 
from  which  he  finally  died  on  August  2,  1877.  Prior  to  the 
winter  of  1S76  he  had  been  very  fond  of  society,  had  always 
been  neat  in  appearance,  and  had  always  been  kind  and  con- 
siderate to  the  members  of  his  household  ;  but  after  that  time 
he  secluded  himself,  became  slovenly,  and  frequently  abused 
and  assaulted  the  members  of  his  household.  He  was  eccen- 
tric in  dress  and  at  the  execution  of  the  will  appeared  dressed 
in  a  night-gown  and  Scotch  cap.  After  the  execution  of  the 
will  (in  May,  1877,)  and  up  to  the  time  of  his  death  he  fre- 
quently had  delusions  and  raved  to  such  an  extent  as  to  dis- 
turb his  neighbors.  On  these  facts  five  physicians  believed 
him  insane.  On  a  trial  before  the  jury  a  verdict  was  rendered 
sustaining  the  will,  which  verdict  was,  on  appeal  to  the  Supreme 
Court,  affirmed. 


Case  XVII. — Will  made  by  Lunatic  when  Insanity 
Followed  Organic  Disease  of  Brain. — Not  Sus- 
tained. (  IVas  probably  incompetent  for  some  time  before  the 
will  was  signed.) 

(Matter  of  Sarah  M.  Blakely's  Will,  48  Wis.  294.) 
Sarah  M.  Blakely  executed  her  will  April  7,  1876,  and  it  was 
contested  by  her  husband  on  the  ground  of  insanity.  It 
appears  that  she  had  a  stroke  of  apoplexy  in  December,  1875, 
and  for  some  time  thereafter  was  subject  to  paroxysms  of  grief 
and  crying.  In  April  following  she  executed  the  will.  In  the 
summer  of  1876  she  had  another  stroke  of  apoplexy,  and  on 
Sept.  26  was  sent  to  an  insane  asylum,  where  she  died  March 
10,  1877.  In  February,  1876,  she  wrote  several  clear  and  co- 
herent wills.  For  a  long  period  she  had  manifested  a  great  dis- 
like for  her  husband  and  entertained  groundless  suspicions  ol 
him.  She  was  nervous,  flighty,  excitable  and  hysterical,  dis- 
contented and  unhappy.  Dr.  Barnett  who  attended  her  says 
that  after  the  paralytic  stroke  in  December,  1875,  her  mind  be- 
came enfeebled  and  that  she  was  suffering  from  dementia  and 
did  not  consider  her  in  a  proper  condition  of  mind  to  attend  to 
business  in  the  spring  of  1876.  Drs.  Hunt  and  Russell  testi- 
fied as  to  her  condition  before  the  paralytic  stroke,  that  her 
conduct  might  be  the  result  of  nervous  excitement  or  childish- 
ness. Dr.  Kempster,  Superintendent  of  the  asylum  in  which 
deceased  was  confined,  from  an  examination  made  in  Septem- 


THE    LKGAL    UKI.A'IIONS    OF    INSANITY. 


95 


ber,  1876,  believed  her  to   have   been   of   unsound   mind   in 
April,  1876. 

The  Supreme  Court  (on  appeal)  held  that  deceased  was 
laboring  under  no  insane  delusion  when  she  executed  the  will  ; 
tliat  she  did  not  lack  testamentary  capacity  ;  and  that  the  will 
was  correctly  admitted  to  probate. 


Case    XVIII. — Cerebral   Disease,  Softening,  Dementia, 
Undue  Influence — Will  not  Sustained. 

Cherbonnier      1 

vs.  \         56  Maryland  Reports,  276. 

Evitts,  ) 

Seth  H.  Evitts  died  September  22,  1877,  aged  eighty  years. 
On  August  27,  1875,  he  executed  a  will  bequeathing  to  plaintiff 
all  his  property  with  the  exception  of  a  few  small  items.  On 
April  2,  1876,  and  September  22,  1876,  he  made  two  other 
wills  which  were  substantially  the  same  as  the  will  of  1875,  the 
only  change  being  in  the  minor  bequests.  These  wills  were 
severally  offered  for  probate  but  rejected  on  the  ground  that 
testator  was  not  of  sound  mind  when  he  executed  them, 
and  the  will  of  1875  was  probated. 

On  December  20,  1876,  deceased  executed  a  deed  to  defend- 
ants, transferring  most  of  his  real  estate.  His  deed  it  is  now 
sought  to  set  aside  on  the  ground  of  mental  incapacity  in  the 
grantor. 

In  setting  aside  the  deed  the  Maryland  Court  of  Appeals 
said,  in  reviewing  the  evidence,  that  after  the  execution  of  the 
will  of  September,  1876,  the  defendants,  through  false  state- 
ments, produced  in  the  mind  of  deceased  an  insane  delusion 
that  plaintiff  was  treating  him  badly  and  robbing  him  of  his 
property  ;  that  he  had  always  been  on  affectionate  terms  with 
plaintiff  ;  that  there  was  no  grounds  for  the  delusion.  That 
he  had  several  strokes  of  apoplexy  in  1876,  and  was  perma- 
nently paralyzed  ;  became  imbecile  ;  was  childlike  ;  had  few 
ideas  ;  his  mind  became  inert  ;  was  easily  controlled  and  in- 
fluenced ;  his  memory  failed  ;  was  unable  to  walk  without 
assistance  and  required  constant  attendance  ;  his  hobby  was 
politics. 

On  this  evidence  the  court  held  that  deceased  was  not  com- 
petent in  mind  when  the  deed  was  executed. 


96  MEDICAL   JURISPRUDENCE. 


Case  XIX. — ^Will — Previous  History  of  Cerebral  Dis- 
ease— Improper  Admission  of  Evidence — Will  Sus- 
tained ON  Appeal. 

Brinkman        ) 

vs.  17'  Missouri  Reports  553. 

Reieggesick,     ) 

Deceased,  some  years  previous  to  his  death,  had  a  sun- 
stroke, and  although  he  had  previously  been  sane  and  rational 
he  thereafter  became  imbecile  and  unable  to  read  or  write  ; 
did  not  care  for  money  ;  never  transacted  business  with  any 
one.  Shortly  before  his  death  he  executed  his  will,  which  is 
now  offered  for  probate.  The  witness  to  the  will  testified  to 
his  soundness  of  mind  at  the  time  it  was  executed.  On  the 
original  trial  the  Circuit  Court  received  the  testimony  of  sev- 
eral witnesses  as  to  rumors  of  the  insanity  of  deceased,  and 
rejected  the  will  on  the  evidence. 

On  appeal  the  Supreme  Court  reversed  the  judgment  on  the 
ground  that  the  Court  erred  in  receiving  hearsay  testimony  as 
to  testator's  incapacity. 

Undue  Influence. — Medical  witnesses  are  frequently  asked 
to  express  an  opinion  whether  the  patient's  mental  disease  is 
not  such  as  to  make  him  an  easy  prey  to  designing  friends  and 
relatives,  who  may  have  ends  of  their  own  to  gain,  and  through 
the  agency  of  undue  influence  may  lead  or  force  the  person  to 
dispose  of  his  property  in  a  way  he  would  not  were  he  in  full 
possession  of  his  faculties.  It  is  sometimes  a  difficult  matter 
to  give  such  an  opinion,  for  although  the  physician  may  have 
no  doubt  of  the  mental  status  of  the  testator,  he  is  often  bound 
by  rules  of  evidence  to  answer  a  badly-drawn  hypothetical 
question  which  is  unscientific  and  negative.  Undue  influence 
may  be  brought  to  bear  in  cases  where  through  disease  the  in- 
dividual is  either  unable  to  reason  correctly,  or  where,  to  avoid 
opposition  and  Avorry,  he  injudiciously  accepts  the  arrange- 
ments made  by  other  people,  or  wliere  his  will  power  is  so 
much  impaired  thnt  he  cannot  resist  well  directed  and  decisive 
demands  of  interested  plotters.  The  suspiciousness  and  unrea- 
sonable delusions  which  the  insane  man  harbors  towards  those 
he  has  always  loved  are  very  often  played  upon  by  interested 
persons,  and  in  certain  stages  of  mania  and  melancholia  as  well 
as  the  first  stage  of  dementia,  it  is  possible  to  lead  the  insane 


THE    LEGAL    RELATIONS   OF    INSANITY.  9) 

individual  to  do  many  unjust  acts  under  the  delusion  that 
indignities  have  been  heaped  upon  him,  and  that  insults  and 
slights  have  been  offered  to  him.  It  may  readily  be  seen  how 
the  subject  of  religious  melancholia  may  be  made  to  give  all 
his  money  to  the  church,  and  instances  of  this  kind  are  ex- 
ceedingly common,  especially  when  the  testator  is  a  woman 
who  is  tortured  with  ideas  of  future  unrest  and  punishment. 
The  majority  of  cases  where  undue  influence  is  alleged  to 
have  been  exercised  are  those  where  there  is  a  history  of  de- 
mentia in  old  people.  The  senile  dement  is  prone  to  make 
foolish  and  trivial  disposition  of  his  property,  and  particularly 
is  this  the  case  when  he  is  aided  by  designing  people  who  sur- 
round him,  and  the  individual  of  this  kind  is  very  apt  to  be 
easily  turned  from  his  original  purpose  by  fresh  suggestions  or 
new  influences.  He  is  liable  to  imposition  and  unjustifiable 
prejudice.  The  Carlton-Gates  case,  reported  by  Dr.  Lee,  is 
one  which  may  be  adduced  as  an  example  where  a  will  had 
been  made  as  the  result  of  undue  influence.  In  this  case  the 
testator  was  of  insane  temperament — "was  impressionable  to 
subtle  and  usually  unrecognized  influences,"  and  under  the 
dominance  of  a  delusion  which  had  been  created  by  a  very 
dear  and  ''particular  friend"  he  committed  an  act  of  injustice 
which  was  clearly  the  result  of  his  insanity.  "  When  it  is  con- 
sidered that  just  before  his  last  visit  to  Europe,  Gates  had 
made  a  will  restoring  the  whole  of  his  property  to  his  mother, 
and  that  it  remained  unaltered  until  his  weak  and  perverted 
mind  had  been  thoroughly  poisoned  against  her,  and  nearly  up 
to  the  time  of  his  death,  when  a  new  will  was  executed  revok- 
ing his  former  bequests  in  favor  of  the  very  individual  who  it 
is  proved  had  caused  the  new  will  to  be  made,  and  who  had 
had  sole  charge  of  Carlton's  person  for  the  last  two  weeks  of 
his  life  ;  such  an  instrument  appears  so  unreasonable,  so  un- 
natural and  unjust  on  its  very  face,  and  bears  upon  it  such 
irresistible  marks  of  intrigue,  dishonesty  and  fraud,  that  it  must 
necessarily  be  rejected. 

"  In  forming  a  judgment  in  this  case  in  regard  to  the  state 
of  mind  of  the  testator,"  says  Lee,  "  I  also  find  sufficient  evidence 
of  insanity  in  the  nature  of  the  will  itself.  To  say  nothing  of  the 
strange  and  unnatural  nature  of  the  bequests  themselves,  prov- 
ing conclusively  the  change  of  feeling  and  disposition  already 
referred  to,  the  confident  expression  of  Carlton's  belief  in  the 
fact  of  his  having  been  poisoned  notwithstanding  the  positive 
assurance  of  all  his  physicians  that  such  was  not  the  fact — the 
direction  to  have  the  contents  of  his  stomach  analyzed  for  the 


g3  MEDICAL    JURISPRUDENCE. 

detection  of  poisons,  supposed  to  have  been  administered 
many  7>ionths  before — he  being  a  medical  man  ;  the  appropria- 
tion of  $25,000  (at  first  named  $50,000)  for  the  prosecution  of 
certain  suspected  persons  not  named  in  his  will  ;  the  gift  of 
the  Yonkers  estate  to  the  corporation  of  Yonkers,  although  he 
knew  he  had  no  legal  title  to  it  and  was  only  trustee  of  the 
property ;  the  false  statement  in  regard  to  his  father  and 
mother,  and  her  income,  imbecility,  etc.,  etc.  ;  when  to  all  this 
we  add  the  extraordinary  fear  and  suspicion  of  detection  and 
discovery,  during  the  drawing  and  execution  of  the  will,  direct- 
ing "  doors  to  be  carefully  closed,"  and  "  to  see  that  no  one 
was  about,"  who  might  possibly  hear  what  was  going  on — all 
this  so  characteristic  of  the  cunning  and  secrecy  of  the  insane, 
proves,  in  connection  with  the  other  circumstances,  the  posi- 
tive insanity  of  the  testator.  There  was,  undoubtedly,  reason 
enough  remaining  to  render  him  conscious  that  he  was  about 
doing  a  wrong,  perverse  and  wicked  act,  for  the  insane  are 
often  able  to  distinguish  between  right  and  wrong,  for,  as  soon 
as  the  will  was  executed,  he  exhibited  no  fear  or  suspicion 
whatever." 

In  general  paresis  the  individual  is  very  apt  to  squander  his 
property  and  to  fall  a  prey  to  the  many  parasites  who  are  ever 
ready  to  take  advantage  of  his  bonhommie  and  boastful  good 
nature.  In  a  recent  case  the  paretic  whose  illusions  of  grand- 
eur were  of  the  most  magnificent  character  became  involved 
in  a  variety  of  schemes  devised  by  ingenious  sharpers,  and 
when  legal  proceedings  were  instituted  it  was  found  that  he 
had  gone  so  far  as  to  buy  for  his  new  friends  a  cargo  of  bric-a- 
brac,  and  to  secure  a  place  for  the  sale  of  the  same  he  had 
Ijought  up  the  stock  of  the  occupant  of  the  store,  spending 
$30,000,  so  that  his  friends  might  take  immediate  possession. 
In  patients  suffering  from  the  first  stages  of  the  disease,  it  may 
readily  be  seen  how  any  one,  by  judicious  flattery  and  acqui- 
escence in  the  startling  projects  and  ideas  of  the  individual, 
may  wheedle  him  into  parting  with  property. 

In  other  forms  of  organic  insanity  a  condition  of  mental 
feebleness  akin  to  dementia  is  manifested  by  irresolution, 
irritability  or  intellectual  torpor.  It  will  frequently  be  found 
that  disease  of  the  cerebral  vessels,  especially  on  the  left  side 
of  the  brain,  is  very  apt  to  be  followed,  if  at  all  extensive,  by 
degeneration  of  the  mental  faculties  ;  and  if  such  degeneration 
is  followed  by  an  early  fatal  result,  and  a  biased  and  unjust 
will  is  made  even  though  there  can  be  brought  forward  very 
few  instances  of   mental  irregularity,  still  we  should  question 


THE    LEGAL    RELATIONS    OF    INSANITY.  gg 

the  ability  of  the  patient  to  withstand  the  arguments  of  inter- 
ested friends. 

Softening  is  so  common  after  accidents  of  the  kind  men- 
tioned above,  and  is  so  frequently  symptomatized  by  loss  of 
memory,  indecision  and  childishness  that  intellectual  compe- 
tency should  always  be  questioned. 


Case   XX. — Undue    Influence — Will  not  Admitted  to 

Probate. 
Greenwood      ) 

vs.  >      7  Oregon  Reports,  17. 

Cline,  ) 

On  October  12,  1872,  Mrs.  Elizabeth  Greenwood,  then  62 
years  old.  executed  her  will.  She  died  August  9,  1875,  leav- 
ing an  estate  worth  $26,000.  By  the  terms  of  her  will  she  be- 
queathed to  two  of  her  children,  Eliza  Smith  and  William 
Greenwood  (the  contestants)  $100  each  and  the  residue  of  her 
estate  to  Olive  Newsome,  a  granddaughter  and  Mrs.  Mary 
Cline  her  remaining  child.  The  will  was  contested  on  the 
ground  that  the  testator  was  of  weak  mind  at  the  time  it  was 
executed  and  unduly  influenced.  It  was  not  claimed,  however, 
that  she  was  incapable  of  executing  the  will  but  that  she  was 
laboring  under  a  delusion  with  regard  to  contestants  brought 
about  by  the  undue  influence  exercised  upon  her  weak  and  im- 
paired mind  by  Mrs,  Cline  and  Mrs  Newsome.  Upon  the  trial 
of  the  issues  in  the  Countv  Court  the  will  was  rejected,  the 
court  holding  that  wliil  ■  deceased  had  testamentary  capacity 
the  will  was  executed  under  undue  influence.  On  appeal  to  the 
Circuit  Court  this  judgment  was  reversed  and  contestants  then 
appealed  to  the  Supreme  Court  who  reversed  the  judgment  of 
the  Circuit  Court  and  rejected  the  will,  on  the  same  ground 
taken  by  the  County  Court,  and  also  sustained  the  claim  of 
contestants  thai,  deceased  was  laboring  under  a  delusion  regard- 
ing them  at  the  time  she  executed  the  will.  The  evidence  which 
is  voluminous  shows  that  deceased  had  a  severe  attack  of  par- 
alysis in  1866  from  the  effects  of  which  she  never  recovered  ; 
that  her  memory  became  defective  ;  she  could  not  tell  who  was 
working  for  het  ;  would  lease  a  piece  of  land  and  forget  it  next 
day  ,  would  ask  the  same  question  repeatedly.  Two  medical 
doctors  who  had  known  deceased  testified  that  she  was  very 
despondent- ;  was  different  from  the  majority  of  people  ;  at 
times  exhibited  mental  obliquity  :  her  mental  DOwers  were  im- 


lOO  MEDICAL    JURISPRUDENCE. 

paired.  Others  testified  her  eyes  had  a  dead  expression  ;  she 
sometimes  acted  like  an  intoxicated  person  ;  in  1872  she  was 
peculiar  in  her  conversation  ;  would  stop  short  while  making  a 
remark  and  fail  to  finish  it ;  was  absent  minded  ;  while  ill  she 
imitated  with  empty  hands  the  action  of  a  person  breaking  a 
piece  of  quartz  and  examining  for  gold  ;  she  very  readily  gave 
up  her  opinions  and  would  side  with  any  body  who  disputed 
them  ;  that  while  going  from  Salem  to  Howell's  Prairie  alone, 
she  became  turned  around  in  the  road  and  was  coming  back  to 
Salem  without  knowing  it  ;  that  she  did  not  appear  cheerful  or 
laugh  ;  paid  no  attention  to  her  housework  ;  she  was  frequently 
told  that  her  m.ind  was  not  right.  That  on  the  day  she  exe- 
cuted her  will  she  submitted  herself  to  a  short  examination  by 
two  doctors  from  whom  she  obtained  a  certificate  of  her  sound 
mind  and  competency  to  make  a  will.  That  Mrs.  Cline  by 
means  of  a  pretended  communication  from  her  deceased  hus- 
band obtained  through  a  spiritual  medium,  stating  that  her  son 
John  W.  was  a  rough  character  and  would  squander  her  prop- 
erty and  that  she  should  get  it  all  out  of  his  hands,  produced  a 
delusion  in  her  mind  regarding  the  character  of  her  son.  There 
was  some  evidence  on  behalf  of  proponents  regarding  the 
sanity  of  deceased  but  as  this  was  admitted  it  is  not  necessary 
to  give  a  resum^  of  the  evidence. 

The  will  was  rejected  on  the  ground  of  undue  influence  ; 
that  it  was  the  offspring  of  a  delusion  regarding  the  contest- 
ants.    (See  Appendix  F.) 

Undue  Influence  in  Relation  to  Crime. — Undue  influ- 
ence directed  to  make  another  an  accomplice  in  crime  is  rare. 
Imbeciles  are  sometimes  persuaded  to  do  acts  of  violence  at  the 
instance  of  designing  persons.  The  risks  are  too  great  and  the 
danger  of  discovery  too  probable,  and  we  rarely  find  that  the 
pressure  of  influence  is  brought  to  bear  as  it  is  in  civil  cases. 
A  case  of  this  kind  where  the  individual  confessed  his  crime 
under  the  dominion  of  an  hallucination  is  that  of  Lecouffe.' 
Lecouffe,  a  young  man,  aged  twenty-four  years,  accused  of  rob- 
bing and  murdering  an  old  woman,  was  brought  before  the  Court 
of  Assizes,  Dec.  11,  1853,  condemned  to  death  and  executed. 
In  the  opinions  of  tliose  who  knew  him  he  had  always  been  an 
imbecile.  His  mother,  notoriously  immoral,  had  entire 
control  over  him.  He  accused  her  of  instigating  him  to 
the  commission  of  the  crime,  and  so  great  was  her  ascendency 
over  him  that  he  was  not  at  all  times  able  to  sustain  this  charge 
in  her  presence.     He  had  some  matrimonial  projects,  and   his 


THE    LEGAL    RELATIONS    OF    INSANITY.  loi 

mother  taking  advantage  of  his  imbecility  had  bribed  his  ac- 
quiescence in  the  perpetration  of  the  crime  ;  and  she  had  be- 
sides appropriated  almost  exclusively  the  proceeds  of  the  theft, 
since,  out  of  the  sum  of  two  hundred  and  fifty  francs,  she  gave 
him  only  forty. 

Lecouffe  at  first  denied  the  charges,  but  finally  made  a  full 
confession.  This  change  appears  to  have  been  very  singularly 
produced.  The  day  after  the  murder,  the  ghost  of  his  father 
had  appeared  before  him,  commanding  him  to  tell  the  truth  ; 
and  he  had  heard  the  voice  of  God  promise  his  pardon  on  this 
condition. 

In  prison  the  jailors  were  surprised  at  his  mental  weakness, 
and  his  incoherent  and  puerile  language.  They  witnessed  sev- 
eral returns  of  convulsive  attacks,  ai  the  end  of  which  a  prey  to 
hallucinations,  he  uttered  dismal  cries.  These  paroxysms  oc- 
curring during  the  trial,  did  not  prevent  the  prosecuting  at- 
torney from  inferring  the  absence  of  insanity  ;  and  he  could 
only  perceive  in  the  false  perceptions  of  the  accused  the  re- 
morse of  a  guilty  conscience. 

In  explaining  these  several  particulars,  Georget  has  skillfully 
shown  the  fallacy  of  the  premises  on  which  the  verdict  was  ren- 
dered. To  him,  the  early  date  of  his  disease,  and  the  frequen- 
cy of  his  attacks,  his  uniform  stupidity,  his  abject  submis- 
sion to  his  mother's  will,  the  strange  phenomena  observed  in 
prison,  and  which  were  probably  not  unusual  to  him,  were  all 
so  many  proofs  that  the  condemned  did  not  possess  full  free- 
dom of  will ;  and  with  insufficient  moral  perceptions,  a  nature 
weak  and  uneducated,  he  was  fatally  predisposed  to  serve  as  a 
ready  instrument  to  any  foreign  suggestions  or  to  his  own  bad 
passions.  Brierre  de  Boismont  m  commenting  upon  the  above 
case  says  :  "  I  admit  that  the  mere  finding  that  this  patient  had 
obeyed  an  obvious  selfish  interest,  dissented  from  the  conclu- 
sions of  Georget,  but  we  have  seen  that  the  intention  which 
governed  the  act  does  not  necessarily  imply  the  possession  of  an 
independent  volition.  Hence  the  elements  of  the  case  upon 
which  Georget  rests  his  view  are  such  as  to  attach  us  to  his 
opinion." 

The  Medico-legal  Relations  of  Aphasia. — The  question 

of  apoplectiform  attacks  in  connection  with  aphasia  arises  fre- 
quently in  cases  in  which  the  testamentary  capacity  of  an  indi- 
vidual is  questioned.  The  occurrence  of  general  arterial  de- 
generation with  its  attendant  accidents,  is  one  which  very  often 
invalidates   the  patient's  capacity   to  know  the  objects   of  his 


I02  MEDICAL    JURISPRUDENCE. 

bounty  and  dispose  of  his  property  in  a  sagacious  manner. 
The  first  indication  of  cerebral  mischief  may  be  tendency  to 
attacks  of  cerebral  congestion  wilh  irritability  of  temper,  forget- 
fulness,  a  disposition  to  burst  into  tears  and  a  condition  of  ex- 
citement, succeeded  by  very  marked  intellectual  disorder 
amounting  to  dementia.  There  may  be  attacks  of  hemiplegia, 
and  they  usually  closely  succeed  each  other.  In  connection 
with  these  there  may  be  a  condition  of  aseinasia  (aphasia), 
which  gives  rise  to  speech  defects  as  well  as  inability  to  com- 
municate by  writing.  The  question  of  aphasia  suggests  sev- 
eral points,  (i).  Whether  the  condition  be  such  as  to  prevent 
the  individual  from  communicating  to  others  the  ideas  he  in- 
tends to  express.  (2).  Whether  his  affection  of  intellect  is  such 
as  to  prevent  him  from  recognizing  the  mistakes  he  may  make 
in  talking  and  writing. 

Aphasia  with  Responsibility. — In  the  determination  of 
the  importance  of  aphasia  as  a  symptom  in  any  particular  case, 
we  must  discover  whether  or  no  it  is  connected  with  insanity. 
In  a  will  case  in  which  I  was  recently  called  to  testify,  the  pa- 
tient had  an  attack  of  right  hemiplegia  with  aphasia.  She  had 
always  been  a  person  of  weak  mind  and  her  mental  degenera- 
tion deepened  towards  the  later  years  of  her  life.  A  peculiarity 
of  her  aphasia,  which  was  complete,  was  that  she  reversed 
"yes"  for  "no,  "  and  then  her  state  of  intellect  was  such  as  to 
prevent  her  from  realizing  her  mistake.  Dr.  Bancroft*  reports 
the  case  of  a  farmer  who  was  aphasic  and  insane.  He  could 
read  printed  or  written  words,  could  see  the  figures  upon  dom- 
inoes, but  could  not  understand  spoken  words  and  he  denied 
being  able  to  read.  He  was  unable  to  understand  that  he  was 
speaking  incorrectly.  This  very  point  is  one  that  has  medico- 
legal importance.  The  sane  aphasic  is  usually  apt  to  realize 
his  mistakes  and  either  attempt  to  correct  them  or  express 
annoyance.  The  insane  aphasic  makes  no  such  attempts  and 
his  mental  condition  is  not  indicative  of  the  fact  that  he  retains 
cognizance  of  his  error. 


Case  XXI. — One  of  the  most  celebrated  cases  is  that  of  Del- 
afield  vs.  Parish.  The  following  report  is  to  be  found  in 
Wharton  &  Stille's  Medical  Jurisprudence  and  is  an  abstract 
from  a  very  interesting  account  of  the  case  published  in  the 
AvaQx'ic^n  Journal  of  Insanity  (Oct.  1862):     The  alleged   loss 

*  Boston  Medical  &>  Surgical  Journal,  Vol.  civ  No.  21  p.  483. 


THE    LEGAL    RELATIONS    OF    INSANITY.  103 

of  understanding  on  the  part  of  Mr.  Parish  was  as  usual  depend- 
ent upon  physical  disease.  He  had  threatenings  of  cerebral 
disturbance  for  several  years  before  his  attack  of  apoplexy  and 
paralysis  iu  1849,  and  had  hereditary  tendency  to  disorders  of 
that  nature.  The  shock  of  this  final  attack  rendered  him  in- 
sensible and  convulsive  for  several  hours. 

It  was  soon  discovered  that  his  right  side  was  paralyzed. 
His  physicians  characterized  the  seizure  as  "  hemiplegia"  lead- 
ing to  "  defect  of  motion  not  of  sensation,"  and  implicatini^ 
"the  right  arm  and  right  leg,  and  also  the  organs  of  speech," 
He  subsequently  acquired  a  slight  control  over  the  right  leg,  but 
the  arm, which  improved  somewhat  after  the  first  six  months  im- 
mediately after  the  attack,  afterwards  entirely  lost  its  power. 
The  left  arm  and  leg  were  not  permanently  affected  by 
paralysis. 

It  is  stated  that  Mr.  Parish  recovered,  in  a  considerable  de- 
gree his  strength  after  the  first  shock,  and  that  during  the  re- 
maining seven  years  of  his  life  he  enjoyed  good,  but  not  unin- 
terrupted, health.  He  suffered  from  a  severe  and  painful  dis- 
ease of  the  bowels,  in  Oct.  1849  ;  subsequently,  he  had  a  num- 
ber of  attacks,  "  distinct  from  the  general  disease,  but  the 
most  frequent  dependent  upon  its  cause,  or,  in  other  words, 
dependent  upon  the  condition  of  the  brain  which  led  to  the 
disease." 

"  He  had  one  or  more  severe  attacks  of  cholera  morbus,  one 
or  more  of  inflammation  of  the  lungs,  an  abscess  formed  at  one 
time  under  the  jaw,  which  became  so  large  as  to  threaten  suffo- 
cation, and  there  were  several  minor  attacks  from  time  to 
time." 

In  addition  to  these  disorders,  ever  after  his  apoplectic  at- 
tack, Mr,  Parish  was  subject,  at  regular  intervals,  to  spasms  or 
convulsions,  the  intervals  extending  from  one  or  two  weeks  to 
six  months,  and  even  a  year.  Their  approach  was  preceded 
by  despondency  and  irritability  on  the  part  of  the  paralytic, 
and  after  the  convulsion  had  passed  off,  he  was  generally  bet- 
ter and  brighter  than  he  had  seemed  before.  The  convulsions 
are  described  as  commonly  coming  on  suddenly  with  a  noise  in 
the  throat  resembling  a  shriek  or  scream,  a  violent  reddening 
of  the  face,  and  a  convulsion  of  the  whole  body — the  muscles 
becoming  alternately  rigid  and  relaxed.  Some  of  these  parox- 
ysms were  so  violent  as  seriously  to  threaten  a  fatal  result.  It 
was  the  opinion  of  Mr.  Parish's  attendant  physician  that  they 
were  "  connected  with  the  condition  of  the  brain  left 
by     the     apoplectic     attack."      The     main     feature    of   Mr. 


I04  MEDICAL    JURISPRUDENCE. 

Parish's  final  illness  was  congestion  of  the  lungs,  but  it  was  a 
complicated  disease  depending,  also,  in  the  opinion  of  his  phy- 
sicians, upon  the  condition  of  the  brain. 

His  power  of  speech  was  mainly  abrogated  on  his  first  attack 
and  from  that  time  to  his  death  he  was  never  able  to  utter  any 
thing  except  a  few  imperfectly  articulated  monosyllables. 
These  were  principally  "yes  "  and  "no,"  which  he  pronounced 
very  imperfectly,  and  there  is  even  great  doubt  whether  he  ever 
uttered  them  intelligibly. 

He  expressed  himself  most  frequently  by  the  use  of  unarticu- 
lated  sounds.  These  are  described  by  witnesses  as  sounds  re- 
sembling the  syllables,  "  yah,  yah,  yah,"  "nyeh,"  "  nin,  nin," 
"yeah,  yeah,  yeah,"  and  others  of  a  similar  character. 

He  accompanied  these  sounds  by  gestures  and  motions  of 
the  left  hand  and  arm,  and  by  nodding  or  shaking  his  head. 
The  gestures  usually  consisted  in  his  waving  his  hand  in  differ- 
ent directions  with  his  fingers  extended,  putting  his  fingers  in 
his  mouth,  or  raising  his  hand  and  shaking  it.  The  external 
senses,  feeling,  hearing  and  smelling,  do  not  appear  to  have 
been  seriously  affected.  His  eyesight  was  always  more  or  less 
imperfect. 

He  would  occasionally  look  at  books  and  papers,  but  the 
preponderating  evidence  was  that  he  could  not  read  at  all.  An 
attempt  was  made  to  induce  him  to  write  with  his  left  hand, 
but  after  several  trials  with  paper,  slate  and  blackboard,  which 
in  one  or  two  instances,  resulted  in  his  writing  after  a  copy  the 
first  few  letters  of  his  name  in  very  doubtful  characters,  the  at- 
tempt was  abandoned. 

Block  letters  were  procured,  but  he  could  not  use  them,  and 
pushed  them  away.  A  dictionary  was  suggested,  but  whether 
the  trial  was  ever  made  or  not,  he  never  adopted  that  method 
of  communicating  his  ideas.  It  was  the  constant  practice  of 
Mr.  Parish's  nurses,  in  accordance  with  his  wife's  directions, 
to  read  the  newspaper  to  him,  but  the  proponents  failed  to 
prove  that  he  ever  manifested  comprehension  of  what  was  thus 
communicated,  or  exhibited  any  intelligent  interest  in  the 
reading. 

Subsequent  to  the  attack  he  was  never  entrusted  with  the 
management  of  his  own  affairs,  nor  allowed  to  have  money  in 
his  possession.  He  could  not  supi)ly  his  own  wants,  and  was 
washed,  dressed,  and  attended  at  table  like  a  child,  and  was 
even  freciuenlly  unable  to  control  his  evacuations. 

His  wishes,  as  might  be  expected,  were  not  easily  ascertained. 
He  expressed,  by  inarticulate  sounds  and  motions  before  re- 


THE    LtGAL    KliLATIONS    OF    INSAMITY.  105 

ferred  to,  that  he  desired  something,  and  various  suggestions 
would  be  made  by  those  attending  him  until  he  expressed  as- 
sent, though  it  often  happened  that  it  was  utterly  impossible  to 
comprehend  him,  and  the  attempt  would  be  abandoned  by 
both  parties.  He  would  also  assent  to  contradictory  sug- 
gestions. 

Before  his  attack,  Mr.  Parish  is  described  by  his  relatives 
and  acquaintances  as  a  "  placid  and  unexcitable  man,"  of  great 
self-respect  and  with  great  command  of  temper;  "  his  manners 
were  mild,  gentle  and  unruffled ;"  a  quiet  undemonstrative 
gentleman,  rarely  exhibiting  any  emotion,  and  deeply  absorbed 
in  his  commercial  transactions. 

After  his  attack  he  manifested  a  marked  change  of  disposi- 
tion; he  occasionally  shed  tears;  and,  in  several  instances,  ex- 
hibited a  want  of  appreciation  of  the  requirements  of  decorum, 
and  even  of  decency.  He  had,  occasionally,  uncanny  freaks 
and  caprices,  such  as  searching  for  his  clothes  in  impossible 
places,  going  out  to  see  the  moon,  and  making  excursions  to 
the  garret  and  the  cellar,  for  no  ascertained  purpose  ;  and  it 
sometimes  became  necessary  to  use  physical  force  to  prevent 
him  from  undertakings  which  threatened  his  personal  safety. 

He  exhibited  some  recollection  of  his  former  daily  and  fami- 
liar places  of  resort,  and  of  his  former  habits  of  business,  which 
he  would  attempt,  in  trifling  matters,  to  resume,  as,  by  pulling 
out  his  watch  when  he  passed  the  City  Hall  clock,  or  insisting, 
when  driven  out,  upon  being  taken  to  the  Bank  of  which  he 
was  once  a  Director,  or  to  his  old  ofhce,  or  to  various  trades- 
men with  whom  he  had  been  in  the  habit  of  dealing.  In  addi- 
tion to  these,  the  proponents,  who  contended  that  Mr.  Parish's 
intellect  was  never  materially  impaired,  brought  forward  many 
particular  instances  in  which  it  was  claimed  that  he  manifested 
undiminished  intelligence.  One  or  two  of  these  may  be  men- 
tioned. 

It  was  said  by  one  witness  :  "  Having  been  riding  out  of  the 
city,  he  would  take  his  \vatch  out  of  his  pocket,  look  at  it,  turn 
round  and  look  at  me,  when  I  would  ask  him  if  he  wished  to 
return,  if  it  was  late  or  about  his  usual  drive ;  he  would  say 
'  yes  '  and  nod  his  head."  Elsewhere,  the  same  witness  says  : 
"  I  recollect,  on  one  occasion,  the  dining-room  clock  was  run 
down  ;  when  he  pointed  at  the  clock,  I  perceived  that  it  had 
stopped  ;  remarked  to  him  that  it  had  stopped,  and  I  would 
wind  it  up,  when  he  nodded  his  head."  An  old  acquaintance 
testified  that  he  recalled  to  Mr.  Parish  a  ridiculous  circumstance 
that  had  happened  to  them  in  company,  many  years  before,  and 


Io6  MEDICAL    JURISPRUDENCE. 

that  Mr.  Parish  "  gave  him  to  understand  that  he  recollected 
the  circumstance,  and  laughed  at  it  quite  heartily,"  These  in- 
stances, however,  of  which  the  above  are  specimens,  were  iso- 
lated, and  takan  together  were  not  deemed  of  sufficient  signifi- 
cance to  avoid  the  conclusion  derived  from  the  facts  before 
stated. 

In  regard  to  the  actual  execution  of  the  codicils,  it  seemed 
that  the  counsel  employed  to  prepare  them  read  them  to  Mr. 
Parish  in  the  presence  of  the  subscribing  witnesses,  put  to  him 
the  requisite  formal  questions,  and  received  from  him  by  sound 
and  gesture,  as  usual,  what  were  supposed  to  be  affirmative  re- 
plies. The  counsel  then  assisted  Mr.  Parish  by  guiding  his 
hand  while  he  made  his  mark.  At  least  this  was  the  case  at 
the  execution  of  the  first  and  second  codicils  ;  there  was  no 
evidence  whether  or  not  he  received  assistance  in  making  his 
mark  at  the  execution  of  the  third. 

Such  were  the  main  points  of  the  case  presented  to  the  Court 
of  Appeals.  The  opinion  of  the  Court  was  delivered  by  Judge 
Davies,  from  which  we  quote  the  comments  upon  the  facts 
which  we  have  narrated,  and  the  conclusions,  in  which  the  ma- 
jority of  the  Court  concurred. 

After  adverting  to  the  change  in  Mr.  Parish's  disposition 
after  his  attack,  Judge  Davies,  says  :  "  How  diametrically  oppo- 
site to  the  previous  conduct  of  his  whole  life  is  that  now  ex- 
hibited. And  the  inquiry  forces  itself  upon  the  mind,  What 
cause  has  produced  such  results  ?  Can  such  totally  incon- 
sistent and  opposite  characters  be  reconciled  with  the  theory 
that  the  faculties,  the  mind,  and  moral  perceptions  of  Mr. 
Parish  underwent  no  change,  but  were  the  same  after  July  19, 
1849,  as  they  were  before  that  day  ?  *  *  We  confess  our- 
selves totally  unable  to  assent  to  any  such  theory.  The  con- 
viction on  our  mind  is  clear  that  these  facts  and  circumstances 
show  unerringly  that  the  attack  of  July  19th  obliterated  the 
mental  powers,  the  moral  perceptions,  the  refined  and  gentle 
susceptibilities,  of  Henry  Parish  ;  that  after  that  period  he 
ceased  to  be  the  mild,  intelligent,  and  unruffled  man  he  had 
been  theretofore,  and  that  thereafter  he  was  not  responsible  for 
the  unbecoming  and  ungentlemanly  conduct  he  so  frequently 
exhibited.  He  then  ceased  to  be  Henry  Parish,  and  was  no 
longer  an  accountable  being."  Upon  the  point  of  Mr.  Parish's 
method  of  communicating  his  ideas.  Judge  Davies  says  :  "  With 
these  imperfect  mediums  for  ascertaining  the  thoughts  of  Mr. 
Parisli,  it  is  doing  no  injustice  to  any  one  to  assume  that  they 
have  been  mistaken  when   they  supposed  that  they  correctly 


THE    LEGAL    RELATIONS    OF    INSANITY.  I07 

understood  him.  We  more  naturally  and  readily  come  to  this 
result,  because  we  find  that  all  who  had  any  intercourse  with 
Mr.  Parish,  on  many  occasions,  found  great  difficulty  in  under- 
standing his  wishes  and  thoughts,  if  they  even  understood  them 
at  all ;  and  the  instances  are  frequent  and  clearly  established 
where  he  often  made  an  affirmative  and  negative  motion  of  his 
head,  immediately  succeeding  each  other,  to  the  same  question, 
leaving  the  inquirer  in  perplexity  which  he  really  intended. 


"  All  the  testimony  shows  that  he  could  only  indicate  with 
his  fingers  and  hands,  or  by  sounds,  that  he  wanted  something, 
or  that  something  was  the  matter,  and  which  motions  or  sounds 
were  construed  by  those  around  him  as  evidences  of  his  wish  to 
put  a  question,  whereupon  they  began  to  suggest  various  topics, 
and  when  they  thought  they  perceived  that  they  had  hit  upon 
the  subject  in  his  mind  they  supposed  he  wished  to  inquire 
about,  they  put  such  questions  as  suggested  themselves  to 
them,  and  to  which  they  supposed  they  had  received  affirmative 
or  negative  answers.  If  Mr.  Parish  had  no  power  to  express  a 
wish  to  destroy  a  will,  it  follows  he  had  none  to  create  one,  and 
the  manifestation  of  his  wishes  depended  entirely  upon  the  in- 
terpreter and  the  integrity  of  the  interpretations. 

"  It  is  thus  seen  that  great  difficulty  and  uncertainty,  to  say 
the  least  of  it,  attended  any  expression  of  the  thoughts  or 
wishes  of  Mr.  Parish,  and  that  a  large  number  of  those  having 
business  or  intercourse  with  him,  utterly  failed  to  attach  or 
obtain  any  meaning  to  his  signs,  sounds,  motions,  or  gestures. 
The  natural  and  obvious  deductions  to  be  made  from  all  these 
facts  and  circumstances  are,  that  Mr.  Parish  had  no  ideas  to 
communicate,  or  if  he  had  any,  that  the  means  of  doing  so, 
with  certainty  and  beyond  cavil  and  doubt,  were  denied 
to  him." 

After  referring  to  the  testator's  failure  to  communicate  by  writ- 
ing, or  by  the  use  of  any  artificial  means,  Judge  Davies  states 
the  final  conclusions  as  follows  : 

"  To  what  result  does  this  review  of  the  facts  and  circum- 
stances in  this  case,  adverted  to  and  commented  on,  lead  the 
mind?  On  a  careful  consideiation  of  them  all,  with  a  most 
anxious  desire  to  arrive  at  a  just  and  correct  conclusion,  we  are 
clearly  of  the  opinion  that  the  attack  of  Mr.  Parish  on  the  19th 
of  July,  1849,  extinguished  his  intellectual  powers,  so  obliter- 
ated and  blotted  out  his  mental  faculties,  that  after  that  period 
he  was  not  a  man  of  sound  mind  and  memory  within  the  mean- 


I08  MEDICAL    JURISPRUDENCE. 

ing  and  language  of  the  statute,   and  was  therefore    incompe- 
tent to  make  a  will.         «■  «■  *  *  *  * 

"It  is  not  the  duty  of  the  Court  to  strain  after  probate,  and 
especially  to  seek  to  establish  a  posterior  will,  made  in  con- 
ceded enfeebled  health,  unsustained  by  previous  declaration  of 
intention,  over  a  prior  will,  made  in  health,  and  with  care  and 
deliberation,  when  the  provisions  of  the  posterior  will  are  in 
direct  hostility  and  conflict  with  those  of  the  prior  one. 


"  It  would  be  in  violation  of  long  and  well  established  princi- 
ples, and  an  almost  uniform  and  unbroken  current  of  decision 
in  England  and  in  this  country,  to  admit  to  probate  testamen- 
tary papers,  prepared  and  executed  under  the  circumstances 
these  were  by  a  man  who  was  in  apparent  full  physical  health, 
and  possessing  nearly  his  natural  strength,  who  could  not  or 
would  not  write,  who  could  not  or  would  not  speak, 
who  could  not  or  would  not  use  the  letters  of  the 
alphabet  or  even  a  dictionary,  for  the  purpose  of  convey- 
ing his  wishes,  upon  proof  solely  that  they  were  supposed  to 
express  the  testator's  wishes  from  signs,  gestures  and  motions 
made  by  him,  and  especially  when  it  appeared  that  such  signs, 
gestures  and  motions  were  often  contradictory,  uncertain,  fre- 
quently misunderstood,  and  often  not  comprehended  at  all." 

Dr.  Hughes*  of  St.  Louis,  in  a  paper  upon  the  medico-legal 
bearings  of  aphasia,  takes  as  his  text  the  case  of  Wm.  T. 
Bevin  vs.  Powoll  et  al.  In  this  case  the  patient's  family  con- 
sidered him  insane  at  the  time  of  making  a  deed  of  trust,  but  it 
appears  from  the  evidence  that  such  was  not  the  case  and  his 
aphasia  was  not  such  as  to  prevent  him  from  expressing  himself 
in  other  ways. 


Case  XXII.— "On  the  13th  day  of  March,  1873,  Mr.  Wm.  T. 
Bevin,  a  few  months  after  the  death  of  his  wife,  was  stricken 
with  right  hemiplegia,  and  aphasia.  A  cardiac  valvular  lesion 
preceded  the  paralysis  and  is  still  persistent.  At  the  time  of 
my  last  examination,  February  7,  1876,  I  found  his  respira- 
tions, without  discoverable  ])ulmonary  lesion,  to  be  twenty-one 
per  minute,  and  the  heart  and  wrist  ])ulsations  asynchronous, 
the  latter  counting  as  high  as  one  hundred  and  eight,  and  the 
former   sometimes    ten  to  eighteen  more,  per  minute.     At  this 

*  American  Journal  of  Insanity,  January,  1879. 


THE    LEGAL    RELATIONS    OF    INSANITY.  lOg 

time  there  was  incomplete  ijaralysis  of  motion  on  the  right  side 
and  general  anaesthesia.  He  was  insensible  to  the  pricking  of  a 
pin  in  both  hands  and  feet.  The  sublingual  temperature,  on 
either  side  was  96°  F.  He  correctly  and  promptly  comprehended 
oral  signs,  but  tardily  and  imperfectly  understood  written  ones. 
He  soon  recognized  my  name  and  wrote  it  for  me,  with  his  left 
hand.  He  likewise  wrote  his  own  name  and  the  surname  of 
his  attorney  (Mr.  Rainey),  upon  my  asking  them.  An  H, 
written  by  myself,  and  an  imperfectly  erased  tracing  of  my 
surname,  were  on  the  card  on  which  he  wrote  my  name.  He 
first  attempted  to  attach  "  ughes  "  to  the  H  I  had  written,  but 
afterwards  changed  his  mir.d  and  made  an  H  of  his  own,  which 
accounts  for  the  somewhat  disjointed  appearance  of  the  word 
Hughes ; 


His  tongue  was  clear,  but  he  said  he  always  had  a  disagree- 
able taste  in  his  mouth.  He  either  really  had,  or  feigned,  de- 
fective vision.  When  the  thumb  was  held  up  before  him,  look- 
ing with  one  eye,  the  other  being  blind-folded,  he  would  say  it 
was  two,  and  when  the  thumb  and  little  finger  were  held  up,  he 
would  say  they  were  three.  I  intended  making  an  ophthal- 
moscopic examination,  but  before  I  had  an  opportunity  the  case 
came  on  trial,  and  my  testimony  not  being  satisfactory  to  the 
family,  I  did  not  offer  to  examine  him  further.  He  either  had 
defect  of  hearing  in  the  left  ear,  or  feigned  it.  I  could  not  cer- 
tainly determine  which.  He  signed  that  he  could  not  hear  the 
ticking  of  a  watch  half  an  inch  from  his  ear,  yet  he  distinctly 
understood  a  remark  addressed  to  him  by  his  sister  in  quite  an 
ordinary  tone,  at  least  twelve  feet  off  from  him,  at  the  time  I 
was  testing  his  hearing.  None  of  the  family  spoke  to  him  in  a 
very  high  tone,  as  is  customary  when  one  is  deaf.  He  repeated 
the  word  nin-jiin,  accompanied  by  a  nod  of  the  head,  to  signify 
yes  and  by  a  horizontal  turning  to  indicate  no.  When  I  wrote 
W.  T.  Bevin  and  asked  if  that  was  his  name,  he  shook  his  head 
and  taking  the  pencil  wrote  Wm.  T.  Bevin  :  He  had 
three  paralytic  strokes,  and  was  seen  by  his  relatives  after 
each  attack.  He  has  grown  steadily  better,  and  they  now 
regard  him  as-perfectly  rational,  but  considered  him  unsound  of 
mind  on  the  fifteenth  day  of  July,  1873,  four  months  after  his 


110  MEDICAL    JURISPRUDENCE, 

first  seizure,  when  he  signed  with  his  left  hand  a  deed  of  trust 
of  his  portion  of  some  houses  he  was  building  jointly  with  some 
other  parties,  and  in  fulfillment  of  a  promise  and  purpose, 
made  and  entertained  prior  to  his  attack.  He  could  not  write 
with  his  left  hand  before  he  was  stricken.  About  the  time  of, 
and  prior  to  the  signing  of  this  deed  of  trust,  he  is  said,  by  some 
of  the  members  of  his  family — principally  his  two  sisters  and  a 
brother-in-law  with  whom  he  lived  and  is  now  living — to  have 
done  some  things  which  they  swore  they  regarded  as  evidences 
of  insanity,  such  as  on  one  or  two  occasions  (none  of  the  wit- 
nesses testifying  to  more)  bowing  to  pictures  in  the  parlor, 
when  he  knew  members  of  the  family  were  present,  and  with  a 
pleased  but  silly  smi^le  on  his  countenance.  Once  he  is  said  to 
have  wiped  his  nose  on  his  napkin,  and  once  or  twice,  in  the 
early  stage  of  his  paralysis,  they  say  he  spat  on  his  plate. 
Once  he  unbuttoned  his  drawers  when  his  sister  and  another 
lady  were  in  the  room.  It  was  said  that  once,  shortly  after  his 
first  stroke  of  paralysis,  he  defecated  in  bed.  Once,  he  is  said 
to  have  struck  his  mother  with  a  stick,  though  one  of  his 
brothers,  who  swore  there  would  have  been  no  suit  if  he  had 
got  his  three  per  cent,  commission,  as  promised,  for  taking  his 
afflicted  brother's  place  in  conducting  the  work,  never  saw  or 
heard  of  his  bowing  to  pictures,  striking  his  mother,  or  un- 
buttoning his  drawers. 

"  Some  time  in  the  June  following  the  stroke  of  paralysis,  he  re- 
cognized and  pointed  at  the  picture  of  the  crucifixion,  and 
other  objects  when  asked  to  point  them  out.  At  this  time  he 
could  not,  the  family  say — all  but  one  brother — distinguish 
letters  or  tell  if  they  were  upside  down  or  not,  but  readily  recog- 
nized them  if  their  names  were  called.  As  early  as  the  first  of 
May,  1873,  he  could  sit  in  a  chair  and  get  about  the  room.  In 
June  he  appeared  to  one  of  his  physicians  to  be  silly,  "  because 
he  smiled  peculiarly  "  and  was  exceedingly  violent  and  irritable 
when  the  battery  was  applied.  To  another  of  his  physicians 
he  appeared  demented,  though  he  was  able  to  go  unaccom- 
panied in  the  fallowing  November,  a  long  distance  to  this 
physician's  office,  correctly  select  and  count  his  money  and  pay 
his  medical  bill,  and  take  and  put  away  carefully  a  receipt  for 
the  same.  It  was  said  also  that  he  made  grimaces  before  a 
glass  once  or  twice,  and  pulled  out  his  hair,  and  he  ate  things, 
when  set  before  him,  tliat  he  never  ate  before.  He  handled  his 
food  with  his  fingers  (he  could  not  use  a  knife  and  fork),  and 
his  manners  and  tastes  at  table  were  changed  in  some  other  re- 
spects, he  having  been  formerly  very  fastidious  and  precise." 


THE  Legal  RfcLATioNS  of  insanitv.  m 

*'  When  he  first  learned  to  write  his  name  he  would  make  signs 
to  visitors  for  a  slate,  write  his  name  for  them,  and  express  his 
pleasure  at  the  accomplishment  by  a  peculiar  smile.  After  the 
description  of  his  property,  mentioned  in  the  deed  of  trust,  was 
read  to  him,  he  pointed  in  the  direction  of  it  and  gave  an  as- 
senting nod,  pointing  immediately  after  in  the  direction  of 
other  property  not  alluded  to  in  the  document,  and  indicating 
his  understanding  tl\at  it  was  not  included,  by  the  usual  turning 
away  of  the  head  indicative  of  dissent. 

"  He  was  attended  by  different  physicians  during  the  first  at- 
tack. The  physician  who  first  saw  him  at  the  time  of  his  first 
seizure  found  him  only  partially  paralyzed  on  the  right  side, 
with  consciousness  still  remaining,  and  helped  him  home.  In 
six  hours  after  this  physician  saw  him  he  was  hemiplegic  and 
unconscious,  and  so  remained  for  several  days.  He  commenced 
to  improve  in  two  or  three  weeks.  He  was  then  annoyed  by 
movements  about  the  room  and  exhibited  '  not  much,  but  some 
signs,  of  intelligence  in  his  countenance.'  He  made  signs  and 
efforts  to  convey  ideas,  and  would  mumble  unintelligibly  in 
answer  to  questions  and  had  difficulty  of  deglutition.  He 
never,  at  any  time,  had  delirium,  delusion  or  hallucination" 


CaseXXIII. 

A  recent  case  of  some  interest,  where  the  question  of  apha- 
sia arose  among  others,  is  that  of — 
Legg  ) 

vs.  )r     5  Redfield's  Reports,  628. 

Meyer,  ) 

(Will  of  Ephraim  P.  Meyer.) 

The  testator  instructed  one  J.  K.  Merritt  to  prepare  a  codi- 
cil to  his  will  and  gave  him  written  memoranda  for  such  codicil. 
Shortly  afterwards  he  was  smitten  with  apoplexy,  resulting  in 
paralysis  of  mind  and  body,  and  lost  his  power  of  speech.  He 
subsequently  recovered  and  although  he  was  never  able  to  talk 
again  he  became  able  to  read  the  Bible  and  daily  papers,  A 
few  weeks  after  his  recovery  he  executed  the  codicil  and  its 
probate  was  contested  on  the  ground  that  tesLitor  did  not  have 
testamentary  capacity  at  the  time  of  its  execution. 

The  court  held  that  although  the  codicil  differed  in  a  few  re- 
spects from  the  memoranda  made  by  deceased  before  his 
illness,  yet  such  memoranda  was  sufficient  proof  of  his  intention 
to  alter  the  provisions  of  his  will.  That  although  his  mind  and 
faculties  were  enfeebled  by  his  illness,  he  had  sufficient  mind 
to  comprehend  the  nature  of  the  codicil. 


112  MEDICAL  JURISPRUDENCE. 

Another  case  is  reported  by  Lucas  Champonniere  illustrating 
the  fact  that  aphasia  may  exist  with  slight  intellectual  perversion, 
not  sufficient  in  itself  to  destroy  the  patient's  capacity  to  dis- 
pose of  his  property  or  make  judicious  contracts.  I  have  al- 
ready referred  to  this  case  in  another  work,  where  the  subject 
of  aphasia  is  more  thoroughly  considered.* 

''  The  question  was  raised  in  this  particular  instance  apropos 
of  a  case  in  which  the  patient,  in  spite  of  an  enfeebled  intelli- 
gence, had  become  capable  of  writing  with  the  other  hand.  He 
could  not,  however,  write  if  left  to  himself,  and  could  only  recopy 
what  was  written  and  set  before  him,  and  the  expert  physicians 
vainly  tried  to  make  him  recopy  a  power  of  attorney  or  a  will, 
while  he  willingly  wrote  any  ordinary  phrase  or  document 
which  did  not  bind  him  to  any  thing.  This  man,  then,  knew 
perfectly  what  he  was  doing,  and  the  Societe  de  Medecine 
Legale  concluded  that  he  possessed  still  thorough  intelligence 
and  free  will  to  be  able  to  continue  to  enjoy  his  civil  rights,  the 
intellectual  debiUty  which  he  had  suffered  not  appearing  to  be 
-sufficient  to  justify  what  the  French  laws  call  an  'interdic- 
tion.'" f 

Tlie  Handwriting  of  tlie  Insane. — The  handwriting  of 
the  insane,  as  presented  in  contracts,  wills  or  other  documents, 
or  in  their  letters,  often  shows  singular  evidences  of  the  dis- 
ordered state  of  mind  of  the  writer.  Not  only  are  we  to  look 
for  insane  peculiarities  in  the  literary  style  of  the  pef'son,  but 
the  substance  of  the  letter  itself  is  often  an  index  of  irresponsi- 
bility and  incompetency. 

The  chirography  is  often  illegible  because  of  omissions  and 
interlineations.  The  page  may  be  so  ''cross-hatched"  with 
lines  as  to  be  all  but  undecipherable.  Many  words  are  sub- 
stituted or  transposed,  and  there  may  be  scrawls  and  diagrams 
which  are  meaningless.  The  handwriting  of  the  general 
paralytic  is  perhaps  the  most  interesting,  and  it  is  well  to  com- 
pare a  series  of  letters,  some  written  during  undoubted  mental 
health  and  others  at  different  stages  of  the  disease.  In  the 
latter  it  will  be  found  that  letters  are  omitted  or  imperfectly 
formed,  or  later  that  the  peculiar  delusions  of  the  writer  are  re- 
produced. 

u 

Business  Contracts. — In  contracts  which  are  questioned 
because  of  the  alleged  insanity  of  one  of  the  parties  it  is  neces- 

*  Nervous  Diseases,  their  Description,  etc.;  2d.  Ed.,  p  197. 
f  British  Medical  Journal.September  15,  1877. 


THE    LEGAL    RELATIONS    OF    INSANITV,  II3 

sary  to  examine  not  only  the  individual  but  the  instrument.  If 
it  is  discovered,  in  addition  to  the  insanity  of  the  contracting 
party,  that  the  bargain  is  clearly  disadvantageous  to  him,  the 
question  of  fraud  and  imposition  is  raised.  It  sometimes  hap- 
pens, on  the  other  hand,  that  the  question  of  mental  unsound- 
ness is  agitated  when  it  is  the  aim  of  a  person  to  shirk  a  respon- 
sibility. In  a  recent  case  in  which  I  appeared,  the  question  of 
melancholia  was  urged,  and  it  was  averred  that  the  plaintiff  had 
made  a  contract  under  the  impression  that  his  business  was  in 
a  ruinous  condition,  and  that  this  was  a  delusion  resulting  from 
melancholia.  In  this  case  I  was  unable  to  find  any  character- 
istic intellectual  derangement,  but  only  simple  emotional 
disturbance  of  a  depressing  character.  I  found  that  his 
view  of  the  state  of  his  affairs  was  perfectly  in  accord- 
ance with  the  real  facts  ;  that  the  contract  was  dictated  by 
him  and  contained  pertinent  marginal  corrections  and  inter- 
lineations ;  that  his  letters,  written  at  the  time,  were  intel- 
ligent, and  that  his  motives  in  bringing  the  suit  were  to  upset 
a  bargain  that  did  not  bring  him  subsequently  what  he  consid- 
ered to  be  his  proper  share  of  the  business  he  conducted  with  the 
contracting  parties.  We  must  take  cognizance  of  the  fact 
in  such  cases  as  this,  as  well  as  others,  that  no  question  of  the 
insanity  existed  at  the  time  of  the  alleged  imposition  ;  that  usu- 
ally the  friends  of  the  person  do  not  consider  it  necessary  to 
seek  legal  advice,  and  it  is  not  necessary  to  resort  to  an  asylum 
or  other  means  of  protection.  Casper  relates  a  case  of  interest 
in  this  connection  : 

"  In  a  civil  process  the  accused  merchant,  W.,  asserted  that 
from  his  ailing  condition  he  was  unable  to  prepare  a  statement 
of  his  affairs  and  to  confirm  it  by  an  oath.  I  had  to  satisfy 
myself  in  regard  to  this,  and  at  the  same  time  to  give  an  opinion 
whether  he  could  be  arrested  personally,  if  necessary.  The  in- 
vestigation proved  that  W.  certainly  labored  under  the  well- 
known  disease  called  hypochondria,  which  in  itself  could  be  re- 
garded as  a  mere  simulation,  though  it  could  not  be  denied 
that  the  manifold  ailments  alleged  to  exist  were  either  inten- 
tionally or  unintentionally  exaggerated.  '  Granting,  however,' 
I  said,  '  that  W.  is  ill,  nevertheless,  since  he  is  not  feverish  nor 
confined  to  bed  and  is  of  clear  intellect,  it  is  not  easy  to  see 
why  such  an  employment  as  the  one  in  question,  the  prepara- 
tion of  a  statement  of  his  affairs  in  his  own  apartments,  should 
be  impossible  for  him  or  likely  to  be  injurious.  When  he 
alleges  that  the  mere  addition  of  sums  causes  him  anguish,  such 
a  statement  is  to  be  rejected  as  inconsistent  with  medical  ex- 


114  MEDICAL  Jurisprudence. 

perience.  Only  if  he  were  to  be  forced  and  hurried  in  the  per- 
formance of  such  a  work  could  there  be  a  possibility  of  injury 
resulting."  Accordingly  I  declared  that  W.  was  in  a  fit  condi- 
tion to  prepare  a  statement  of  his  affairs  and  to  confirm  it  by 
oath,  provided  a  few  weeks  were  granted  to  him  for  this  pur- 
pose, and  that  if  necessary  he  might  be  personally  arrested. 
This  opinion  vas  communicated  to  W.  and  a  statement  of  his 
affairs  was  very  speedily  thereafter  handed  in." 

The  following  case  relates  to  the  validity  of  a  promissory 
note  drawn  by  a  person  who  shortly  afterwards  became  insane  : 


Case  XXIVo 

Stigers      ) 

V.  \      50  Md.,  214. 

Brent,       ) 

On  July  I,  1874,  and  November  i,  1874  John  J,  Brosius 
executed  two  promissory  notes=  Suit  was  brought  upon  them 
in  November,  1876,  and  judgment  obtained  February  12,  1877. 
On  March  10,  1877,  it  was  judicially  declared  in  a  proceeding 
de  lunatico  tngidrendo  that  Brosius  was  a  lunatic  and  had  been 
since  August  i,  1875.  It  was  conceded  that  Brosius  was  of 
sound  mind  at  the  time  he  executed  the  notes,  but  it  was 
claimed  that  he  was  a  lunatic  at  the  time  suit  was  brought.  The 
Circuit  Court  for  Washington  County  held  that  Brosius  was 
liable,  and  on  appeal  to  the  Supreme  Court  of  Maryland  this 
judgment  was  affirmed. 


Case  XXV. — Deed  made  by  an  Alleged  Lunatic  Declared 

Void. 

Turner      ) 

V.  >      53  Maryland  Reports,  65. 

Rusk,       ) 

William  L.  Rusk,  who  had  previously  been  successful  in 
business  in  the  City  of  Baltimore,  and  was  remarkable  for  his 
energy  and  industry  and  shrewdness,  Avas,  on  April  19,  1861, 
suddenly  thrown  into  a  condition  of  intense  excitement,  caused, 
it  was  believed,  by  the  military  ])reparations  and  excitements  of 
those  times.  He  remained  in  this  condition  for  some  time  and 
was  removed  to  the  residence  of  his  sister,  and  finally,  in  the 
latter  part  of  May,  was  admitted  to  have  been  insane.  His 
disease  was  declared  to  be  a  case  of  general  brain  trouble 
caused  by  the  financial  excitement,  etc.,  of  that  period.  On  De- 
cember 27,  1862,  while  residing  wiili  his  sister,  he  executed  a  deed 


THE    LL-GAL    relations    OF    liSTSANlTY.  H^ 

for  a  nominal  consideration  of  property  valued  at  upwards 
of  $10,000  to  Robert  Turner  in  trust  for  his  mother  who  was 
then  75  years  old,  and  after  her  death  absolutely  to  his  sister. 
He  left  his  sister's  in  1864  and  lived  with  his  mother  until  1875 
when  she  died,  and  after  her  death  the  cestui  qui  trust  claimed 
the  property  named  in  the  deed.  He  then  brought  suit  to  have 
the  deed  set  aside  on  the  ground  that  he  was  not  mentally  cap- 
able of  making  a  valid  deed  at  the  time  it  was  executed,  and 
the  deed  was  declared  void.  It  was  shown  that  although  the 
property  stood  assessed  in  his  name  that  no  mention  of  the 
transfer  had  ever  been  made  to  him,  and  he  claimed  to  have  no 
recollection-  It  was  also  proved  that  he  was  incapable  of 
transacting  business  at  the  time  of  the  execution  of  the  deed, 
and  that  he  had  not  completely  recovered  from  the  effects  of 
his  attack  in  1861  until  several  years  thereafter. 

On  appeal  to  the  Court  of  Appeals  the  judgment  declaring 
the  deed  void  was  affirmed. 


Case  XXVI. — Contract  Alleged  to  Have  Been  Made  by 
AN  Insane  Person — Contract  Sustained. 

Kneedler's  Appeal.     92  Penna.  State  Repts.,  428. 

Solomon  A.  Kneedler  through,  his  counsel,  on  August  18, 
1876,  borrowed  $5,000,  giving  as  security  a  mortgage  on  prop- 
erty in  the  City  of  Philadelphia.  This  money  he  used  to  pay 
off  a  mortgage  on  some  other  property.  He  was  afterwards,  on 
March  2,  1877,  adjudged  to  have  been  insane  at  the  time  of 
this  transaction,  and  subsequently,  the  mortgage  having  mean- 
time been  foreclosed  and  judgment  rendered  thereon,  by  de- 
fault, he  began  these  proceedings  to  have  the  judgment  opened 
in  order  that  he  might  plead  his  insanity  as  a  defense,  but  the 
Court  dismissed  the  proceedings.  On  appeal  to  the  Supreme 
Court  the  dismissal  was  affirmed,  the  Court  saying  that  though 
Kneedler  was  insane  at  the  time  he  executed  the  mortgage,  it 
was  undoubtedly  a  sane  act.  He  did  so  through  advice  of 
counsel,  and  applied  the  proceeds  to  a  judicious  purpose. 

The  Question  of  Dissolution  of  Partnership  hy  Rea- 
son of  Insanity. — In  the  matter  of  business  associations, 
especially  when  the  interest  of  one  member  is  monied,  and  that 
of  the  other  is  the  experience  and  "brains"  he  brings,  lawsuits 
may  arise  and  attempts  at  dissolution  growing  out  of  the  in- 
sanity of  one  member  of  the  firm  and  the  consequent  danger 
that  mutual  interests  may  be  wrecked.     The  sane  party  may  de- 


Tl6  MEDICAL    JURISPRUDENCE, 

mand  an  inquisition  upon  proof  of  the  insanity  of  the  other  so 
that  the  co-partnership  may  be  dissolved. 

Impeacliment  by  Reason  of  lusanity. — Tn  the  matter  of 
guardianship,  where  the  trust  funds  are  being  squandered,  or 
where  the  protection  of  the  ward  demand  it,  steps  may  be  taken 
for  the  deposition  of  the  guardian.  The  most  painful  cases  are 
those  where  the  medical  man  is  required  to  testify  as  to  the  inca- 
pacity from  old  age  or  mental  disease  of  an  officer  holding  a  posi- 
tion of  public  trust.  It  cannot  be  denied  that  even  learned  judges 
whose  long  and  honorable  service  has  resulted  in  mental  decay 
are  able  in  a  routine  way  to  go  through  with  familiar  duties  of 
the  past,  and  in  fact  those  mental  operations  which  become 
automatic  are  apt  to  fail  long  after  minor  perversions  have  at- 
tracted the  attention  of  his  immediate  friends  and  family.  In 
such  cases  the  office  of  the  medical  man  is  a  disagreeable  one, 
and  he  should  act  with  more  than  ordinary  care  and  prudence. 
No  blow  is  so  great  as  that  inflicted  upon  a  sensitive  and  high- 
minded  person  when  he  is  made  certain  of  his  intellectual 
failure.  The  symptoms  of  ordinary  disease  or  temporary 
manifestations  of  overwork  should  never  form  the  basis  for  a 
hastily  expressed  opinion. 

Marriage  and  Insanity. — It  sometimes  happens  that  an  at- 
tempt is  made  to  invalidate  a  mar?'iage,  one  of  the  contracting 
parties  being  insane  at  the  time.  It  may  be  that  the  person 
in  whose  aid  the  power  of  the  courts  may  be  exercised  is  at  the 
time  of  marriage  a  declared  lunatic,  in  which  case  all  that  is  re- 
quired is  a  showing  of  the  finding  of  a  previous  commission. 
More  often  the  contracting  party  is  one  of  weak  mind  who  has 
been  entrapped  by  designing  persons.  The  same  influences  that 
may  have  been  brought  into  play  to  make  him  link  himself 
with  some  prostitute  or  adventuress  may  be  brought  to  bear  to 
make  him  an  earnest  defendant  when  his  family  bring  action 
to  set  aside  the  marriage. 

In  such  a  case  he  is  amply  provided  with  friends  and  advice 
who  supply  the  brains  he  unfortunately  does  not  pos- 
sess. It  will  be  readily  seen  that  the  sexual  perversion  insepa- 
rable from  various  forms  of  insanity  may  lead  to  a  union  per- 
haps with  some  one  far  beneath  the  patient,  and  the  influence 
of  nymphomania  leads  to  impulsive  acts  which  the  per- 
son, who  perhaps  is  an  hysterical  girl,  does  not  stop  to 
consider.  The  celebrated  English  case  of  Miss  Bagster  is  an 
example  of  this  kind.  "  Miss  Bagster  was  proved  by  the  evi- 
dence to  be  a  frivolous  and  weak  minded  girl  whose  education 


THE  LEGAL  RLLATIONS  OF  INSANITY.         IIJ 

had  been  much  neglected.  Slie  was  a  lady  of  fortune,  and  she 
ran  away  with  and  was  married  to  a  Mr.  Newton.  An  appli- 
cation was  made  by  her  family  to  dissolve  the  marriage  on  the 
ground  that  she  was  of  unsound  mind.  Amongst  other  facts 
urged  before  the  commission  as  proof  of  tlie  allegation  it 
was  mentioned  that  she  was  occasionally  violent  and  self- 
willed,  that  she  was  passionate  as  a  child,  and  that  even  in  ma- 
turer  years  she  had  httle  or  no  self-control.  That  she  was  igno- 
rant of  arithmetic,  and  therefore  incapable  of  taking  care  of 
her  property.  That  she  had  some  erotic  tendencies  which 
were  evinced  by  her  want  of  womanly  delicacy  and  by  her 
having  engaged  herself  with  a  view  to  marriage  to  several  in- 
dividuals. On  her  examination  before  the  commissioners  her 
answers  were  intelligent,  and  her  conduct  in  no  way  different 
from  that  of  ordinary  individuals.  Seven  medical  witnesses 
were  summoned  to  support  the  commission,  and  each  of  them 
deposed  that  she  was  unsound  mind.  The  commissioners,  how- 
ever, had  recourse  to  Drs.  Morrison  and  Haslam,  who  visited 
her  and  who  came  to  the  conclusion  that  she  was  neither  imbe- 
cile nor  idiotic,  and  that  her  inability  to  manage  her  affairs  arose 
from  ignorance.  She  was  aware  of  her  deficiencies,  and  de- 
plored her  ignorance  of  arithmetic,  and  explained  it  on  the 
ground  that  her  grandfather  had  been  too  ready  to  send  ex- 
cuses for  idleness  when  she  was  at  school.  Her  conversation 
greatly  impressed  Drs.  Haslam  and  Morrison  with  a  belief  in 
her  sanity.  The  jury  by  a  majority  of  twenty  to  two  returned 
a  verdict  that  Miss  Bagster  had  been  of  unsound  mind  since 
November,  1830,  and  the  marriage  was  consequently  dissolved." 

Breacli  of  Promise  and  Insanity. — Breach  of  promise 
cases  are  often  defended  upon  the  plea  of  insanity  and  irre- 
sponsibility. In  the  case  of  Harford  vs.  Singleton  it  was  claimed 
that  the  defendant's  softening  of  the  brain  and  insanity  were 
cogent  reasons  for  his  non-fulfillment  of  the  marriage  contract, 
which  plea,  however,  was  unsuccessful. 


Case  XXVII. — Harford  vs.  Singleton. — This  action  was 
defended  on  the  ground  that  at  the  time  defendant  had  prom- 
ised marriage  he  was  advanced  in  life — viz.,  60  years  of  age  ; 
and  that  before  a  reasonable  time  had  elapsed  from  the  request 
to  marry,  namely,  in  May,  1855,  he  was,  by  a  visitation  of  God, 
attacked  by  a  fit  of  apoplexy,  since  which  time  he  was  in  an 
infirm  state  and  afflicted  with  softening  of  the  brain,  in  con- 


Il8  MEDICAL    JURISPRUDENCE. 

sequence  of  which  he  could  not  perform  his  promise  without 
putting  his  life  in  great  peril,  and  hastening  his  death. 

Evidence  was  called,  on  the  part  of  the  plaintiff,  to  prove 
the  engagement  and  to  show  that  no  apparent  impairment  of 
health  or  vigor  remained  after  recovery  from  the  attack. 

It  was  stated  by  defendant's  counsel,  Mr.  Ball,  that  in  1849 
he  had  suffered  from  dropsy  and  disease  of  the  kidneys;  that, 
in  1852,  he  had  an  attack  of  apoplexy  and  congestion  of  the 
brain.  During  the  interval  from  that  time  until  May  last  he 
had  promised  to  marry  the  plaintiff  ;  but  that  in  the  latter  month 
he  was  afflicted  with  another  attack  of  apoplexy,  and  was  now 
suffering  from  paralysis  and  softening  of  the  brain.  The  de- 
fense then  called  several  medical  men  who  had  attended  the 
defendant.  They  testified  that  he  had  had  apoplexy  and  was 
paralytic,  was  suffering  from  loss  of  memory  and  other  mental 
symptoms,  and  that  he  was  liable  to  another  attack,  and  that 
any  excitement  would  increase  the  tendency  to  such  attack,  but 
would  not  say  that  he  might  not  marry  without  imperiling  his  life. 

The  jury  returned  a  verdict  for  the  plaintiff  £300  damages 
and  costs.  The  ground  of  this  verdict,  it  is  said,  was  that  the 
jury  considered  that  an  unreasonable  time  had  elapsed  between 
the  date  of  the  promise  of  marriage  and  the  date  of  the  last 
attack  of  apoplexy. 

Marriages  contracted  in  extremis  are  usually  very  apt  to  be 
dissolved  by  courts  of  law.  Tidy  refers  to  the  case  of  Roche- 
fort,  who  was  married  to  his  former  mistress  on  her  death-bed, 
he  being  taken  from  prison  for  the  purpose.  It  appeared  that 
the  woman  was  in  her  right  mind,  and  consequently  it  was  held 
to  be  valid.  But  where  one  of  the  parties  is  over-awed,  or 
there  is  any  evidence  of  mental  perversion,  the  legality  of  the 
contract  is  questioned. 

The  seduction  of  an  insane  or  irresponsible  person  is  punish- 
able, but  sometimes  the  questions  involved  are  extremely  dif- 
cult  to  decide.  The  case  of  the  People  vs.  Royal  is  one  of  some 
importance,  although  the  theory  of  the  prosecution  is  ])erhaps 
not  in  accordance  with  the  soundest  psychological  doctrines. 

Case  XXVIII. — Rape — Alleged  Irresponsibility  of  Victim 
— Conviction  of  Prisoner — Verdict  Set  Aside  on  Tech- 
nicality. 
People    ) 

vs.         \      53  California  R.,  62. 
Royal,     ) 
Defendant,  who  was  a  practicing  physician  in   Santa  Rosa, 


THE    LEGAL    RELATIONS    OF    INSANITY.  II9 

was  tried  and  convicted  of  rape  committed  on  a  girl  i6  years 
of  age.  Defendant  drove  in  a  buggy  to  the  house  where  the 
girl  lived  and  invited  her  to  go  home  with  him.  (She  was  in 
the  habit  of  visiting  his  wife).  She  assented,  and  on  the  way 
defendant  practiced  "  manipulation  "  on  her.  Upon  arriving 
at  his  office  he  accompanied  her  up-stairs  and  had  carnal  inter- 
course with  her.  There  was  no  evidence  of  force,  but  it  was 
claimed  that  his  manipulation  had  destroyed  her  will  and  there- 
fore rendered  him  as  guilty  of  rape  as  if  he  had  used  force. 
The  girl  testified  that  defendant's  lewd  conduct  during  the 
drive  made  her  so  dull  and  stupid  as  to  be  unconscious  of  the 
act  he  was  performing.  The  conviction  was  made  on  the 
theory  that  defendant's  manipulations  were  equivalent  to  force. 

On  behalf  of  defendant  it  was  claimed  that  defendant's 
manipulations  did  not  amount  to  force,  and  that  he  could  not 
therefore  be  convicted  of  rape,  and,  on  appeal  to  the  Su- 
preme Court  of  California  this  conviction  was  set  aside  on  these 
grounds. 

The  following  case  is  one  where  damages  were  obtained  for 
alleged  mental  disease  as  the  result  of  seduction.  This,  like 
others  of  its  kind,  is  of  an  exceedingly  questionable  character, 
the  defendant  being  held  by  the  law  responsible  for  much  more 
than  that  of  which  he  is  guilty. 

Case  XXIX. 

Blagge    ) 
vs.        \      127  Mass.  Reports,  191. 

Ilsley,      ) 

In  a  suit  for  damages  for  injuries  resulting  from  seduction, 
where  it  was  shown  that  previous  to  such  seduction  the  girl  had 
been  strong  and  well  and  of  gay  and  cheerful  spirits  ;  and  that 
after  her  seduction  she  became  nervous  and  excitable ;  and  as 
no  pregnancy  or  sexual  disease  was  proven,  a  verdict  was  ren- 
dered for  plaintiff,  and,  on  appeal  to  the  Supreme  Court  of 
Massachusetts,  it  was  held  that  this  evidence  was  sufficient  to 
warrant  the  verdict. 

Divorce  and  Insanity. — The  plea  of  insanity  is  often 
urged  as  a  ground  of  divorce,  and  in  one  case  of  which  I 
know  the  husband  of  an  insane  woman  whose  disease  devel- 
oped after  marriage,  brought  suit  for  separation.  In  ordinary 
cases  such  inhumanity  in  disregarding  the  existence  of  tlie 
affection  as  an  unfortunate  calamity  for  which  the  patient  is  no 
more  responsible  than  she  would  be  for  smallpox  or  typhoid 
fever,  rarely  finds  favor  iii  the  eyes  of  the  law  ;  but  it  can  bti 


I20  MEDICAL    JURISPRUDENCE. 

realized  that  in  instances  where  insanity  has  existed  before 
marriage,  and  when  the  husband  or  wife  has  been  kept  in  igno- 
rance of  the  fact  by  the  patient,  or  by  his  or  her  parents  or 
near  relatives,  a  delicate  legal  point  may  arise. 


Case  XXX. — Puerperal  insanity  as  the  basis  of  irrespon- 
sibility is  rarely  advanced  in  civil  cases.  In  fact,  I  know  of 
but  one  case,  that  of  Lady  Mordaunt.  This  was  the  famous 
divorce  case  in  which  a  Prince  of  England  figured  as  a  witness. 
Lady  Mordaunt,  after  her  confinement,  admitted  that  she  had 
committed  adultery  before  the  birth  of  her  child,  and  the  evi- 
dence substantiating  her  story  was  seemingly  very  strong,  for 
entries  in  her  diary  a  year  before  recorded  the  visits  of  a  noble- 
man at  an  hour  of  the  night  inconsistent  with  the  strictest  pro- 
priety. This  occurred  two  hundred  and  eighty  days  before  the 
birth  of  her  child.  It  appeared  from  the  testimony  of  servants 
and  others  that  there  had  been  no  signs  of  any  thing  peculiar  in 
the  conduct  of  Lady  Mordaunt  either  before  or  after  the  birth  of 
her  child,  and  this  was  in  contradiction  of  those  friends,  of  the 
patient  hers  elf,  who  asserted  that  her  confession  was  the  result 
of  a  delusion  ;  for  not  only  had  the  wife  admitted  improper 
relations  with  other  men,  but  swore  that  the  child  was  not  her 
husband's.  The  patient  was  delivered  of  her  child  on  the 
twenty-eighth  of  February,  1869,  and  a  week  or  two  later  made 
her  extraordinary  admission.  The  physicians  called  by  the 
plaintiff  were  inclined  to  think  that  she  was  not  insane,  and 
that  there  was  nothing  in  her  conduct  inconsistent  with  feign- 
ing. The  reasons  assigned  as  evidences  of  her  insanity  were 
of  the  most  extraordinary  description,  but  they  were  met  with 
much  that  was  contradictory.  It  was  shown  that  her  habits 
had  become  filthy,  that  she  destroyed  her  clothing  and  was 
unclean  in  her  habits;  and  in  1870  she  was  demented,  and 
could  not  comprehend  communications  that  were  made  to  her. 
The  jury  and  the  judge  took  this  latter  view  of  the  case,  and 
it  was  decided  that  as  early  as  the  thirtieth  of  April  the  respon- 
dent had  not  sufficient  capacity  to  bring  the  suit,  and  had  been 
unfit  ever  since.  The  charge  of  the  judge  to  the  jury  was,  that  he 
did  not  ask  them  to  say  whether  Lady  Mordaunt  -vas  sane  or 
insane,  but  simply  to  decide  "whether  she  was  or  not  in  such 
a  state  of  mental  disorder  as  to  prevent  her  giving  instructions." 
The  case  was  afterwards  appealed  and  tried  upon  its  merits, 
the  matter  of  insanity  being  left  out  of  the  question,  the  de- 
fendant being  considered  guilty  of  adultery,  and  the  divorce 
was  granted,     Woodman  and  Tidy,  in  commenting  upon  this 


THE    LEGAL    RELATIONS    OF    INSANITY.  121 

case,  say  :  "  It  is  thus  seen  that  insanity  is  no  bar  to  a  decree 
of  divorce,  a  principle  which  seems  to  us  far  from  being  a  safe 
one.  In  a  case  of  murder,  the  evidence  of  other  persons  or 
circumstantial  evidence  may  be  sufficient.  In  the  relations  of 
husband  and  wife,  it  seems  hard  to  punish  the  wife  while  she 
is  unable  to  defend  herself.  At  all  events,  if  the  principle  be 
admitted,  it  seems  unjust  that  a  poor  laborer  should  have  to 
]jay  towards  the  support  of  an  insane  wife  in  Colney  Hatch  or 
Hanwell,  and  be  liable  to  a  prosecution  for  bigamy  if  he  mar- 
ries again,  whilst  the  wealthy  baronet  escapes  almost  scot  free 
and  may  marry  again  if  he  choose." 


Case  XXXI. — Action  for  Divorce  upon  Plea  of 
Insanity,  and  Failure  of  Defendant  to  Support 
Plaintiff — Denied. 


82  Indiana  Repts.,  146. 


Plaintiff  and  defendant  were  married  in  1867.  In  1874, 
defendant  became  insane  and  was  committed  to  an  asylum, 
where  he  has  since  remained.  Plaintiff  instituted  this  suit  for 
a  divorce  on  the  ground  that  defendant  failed  to  support  her. 

The  Supreme  Court,  on  appeal,  held  that  this  did  not  con- 
stitute sufficient  ground  for  divorce  ;  that  the  statute  providing 
for  divorce  where  the  husband  fails  to  support  his  wife,  does 
not  apply  where  such  failure  is  caused  by  mental  or  physical 
disease. 


Case  XXXII. 
Gerhold      ) 

vs.  \      X2  North  Western  Reporter,  811. 

Wyss,        ) 

Plaintiff  and  defendant  were  married  in  "  September  or  Oc- 
tober, 1867."  A  few  days  thereafter  plaintiff  learned  of  de- 
fendant's insanity,  but  continued  to  live  with  her  until  Septem- 
ber, 1881,  when  a  decree  of  separation  was  made.  He  now 
sues  for  her  support  during  the  time  they  lived  together. 

The  Supreme  Court  of  Nebraska  held  that  as  plaintiff  knew 
of  defendant's  insanity  but  continued  to  live  with  her,  he  was 
obliged  to  support  her. 


122  MEDICAL    JURISPRUDENCE. 

Insanity  and  Life  Insurance . — The  question  of  insanity 
in  relation  to  life  insurance  occasionally  arises,  and  is  made  the 
basis  of  refusal  to  pay  the  amount  of  the  policy  upon  the  part 
of  the  companies. 

It  sometimes  happens  that  an  individual  insures  his  life  and 
fails  to  state  that  he  has  suffered  from  a  nervous  disease  which 
is  the  precursor  of  a  form  of  insanity.  A  case  reported  by 
Taylor  and  Tardieu*  is  that  of  a  gentleman  who  insured  his 
life,  afterwards  becoming  insane.  The  company  refused  pay- 
ment, asserting  that  the  assured  was  aware  of  his  malady  when 
he  applied  for  a  policy,  and  refused  to  so  state.  The  jury  de- 
cided for  the  defendant,  and  the  judge  charged  the  jury  that 
they  must  decide  if  the  mental  disease  had  a  tendency  to 
shorten  life,  for  in  this  case  the  dissimulation  that  had  been 
proved  was  important.  If  the  alienation  had  this  tendency 
they  must  decide  in  favor  of  the  defendant. 

One  of  the  oldest  cases  of  this  kind  is  that  reported  by  Beck 
and  the  high  position  of  the  insured  party  gives  the  case  much 
interest. 

"In  1824,  a  policy  was  effected  by  the  Baron  Von  Lindenau 
on  the  life  of  Frederick  IV.,  Duke  of  Saxe-Gotha  and  Alten- 
burg,  in  the  Atlas  Insurance  Company.  The  Duke  died  on  the 
nth  of  February,  1825,  and  the  insurers  refused  to  pay  the 
sum  insured  for. 

"  On  the  trial  it  appeared  that  Lindenau  had  stated  in  his 
application  that  the  Duke  was  not  gouty,  asthmatic,  or  con- 
sumptive, or  subject  to  fits  ;  that  he  had  never  had  apoplexy, 
and  that  he  had  no  disease  tending  to  shorten  life.  Two  phys- 
icians of  the  Duke  certified,  that  since  the  year  1809,  he  had 
Kad  a  dimness  of  the  sight  from  amaurosis  in  the  left  eye,  and 
since  18 19  had  been  ^''hindered"  in  his  speech  from  having  had 
an  inflammation  of  the  chest,  of  which  he  had  been  perfectly 
cured.  In  a  communication  from  an  agent  in  Germany,  it  was 
mentioned  that  the  Duke  had  formerly  led  a  dissolute  life,  by 
which  he  had  lost  the  use  of  his  speech,  and  according  to  some 
that  also  of  his  mental  faculties,  which  however  is  contradicted 
by  the  medical  men. 

"  On  this  the  company,  instead  of  asking  an  ordinary  pre- 
mium of  ;^2  17s.  per  cent,  per  annum,  re(]uircd  £8  per  cent. 

"  It  now,  however,  appeared  that  the  Duke  had  been  afflicted 
with  almost  a  total  loss  of  speech  from  1822  to  the  time  of  his 
death,  which  one  of  the  physicians  attributed  to  local  paralysis, 

*  ^nnales  d'hygiene  publiquc,  Ixxvi,  page  152. 


THE    LEGAL    RELATIONS    OF    INSANITY.  I23 

and  that  he  had  periodical  catarrhal  affections,  accompanied 
with  fever.  The  chamberlain  of  the  Duke,  in  his  examination, 
mentioned  that  he  had  never  complained  of  pain  in  his  head. 
He  ate,  drank,  and  slept  well,  but  could  not  speak.  Dr.  Dorl, 
physician  to  the  Duke,  agreed  that  his  intellectual  faculties 
were  impaired,  although  his  bodily  health  was  good.  On  ex- 
amination after  death,  no  chronic  disease  was  discovered  in  the 
viscera  or  any  part  of  the  trunk  ;  but  in  the  head  was  founda 
large  tumor  six  inches  in  length,  two  in  breadth,  and  one  in 
depth,  which  not  only  pressed  on  the  brain,  but  had  depressed 
the  skull  at  its  base.  It  was  inferred  that  this  tumor  had  com- 
menced in  early  life. 

"  The  defense  was  that  there  had  been  a  suppression  of  ma- 
terial facts. 

"  Dr.  Green,  an  eminent  English  surgeon,  gave  it  as  his  opinion 
that  from  the  history  of  the  case  merely,  there  were  no  symp- 
toms of  organic  disease.  He  further  thought  that  the  tumor  in 
the  skull  must,  during  life,  have  been  in  a  passive  state  ;  and 
from  its  appearance  on  dissection  that  it  must  have  been  formed 
in  early  life.  He  was  only  willing  to  allow  that  the  symptoms 
mentioned  above,  would  lead  to  a  sii,spicion  of  disease  in  the 
head  ;  and  he  was  disposed  to  ascribe  the  difficulty  of  speech 
to  want  of  volition,  and  not  to  tumor  in  the  brain.  In  reply 
however,  to  a  question  of  Lord  Tenderden,  he  answered  :  "  If 
I.,  as  a  medical  man,  was  asked  by  an  insurance  company, 
concerning  the  state  of  a  man's  health,  who  was  unwilling  to 
move,  who  was  subject  to  control  upon  his  intellect,  and  who 
had  lost  his  speech,  I  should  not  consider  myself  at  liberty  to 
forbear  mentioning  these  circumstances."  Lord  Tenderden, 
who  tried  the  cause,  said  this  was  sufficient ;  and  that  he  should 
charge  the  jury,  that  if  any  material  facts  relative  to  the  Duke's 
health  were  concealed,  then  the  policy  was  void. 

"  The  plaintiff  elected  to  be  non-suited,  and  subsequently 
made  an  effort  to  obtain  a  new  trial  but  it  was  refused." 

A  French  decision  holds  that,  if  a  person  applies  for  a  policy 
and  withholds  the  fact  that  he  has  been  insane,  or  has  a  disease 
which  may  lead  to  insanity,  his  policy  is  null  and  void,  and  he 
cannot  expect  the  return  of  the  premium,  even  though  the  per- 
son assured  may  die  of  some  other  disease. 

General  paresis  may  sometimes  enter  into  thequestion  of  life 
insurance.  A  case  is  related  by  Le  Grand  du  Saulle  which 
shows  how  one  of  the  French  companies  was  victimized.  Two 
brothers  went  to  the  office  of  a  Parisian  alienist,  and  the  elder 
had  a  private  consultation,  the  result  being  that  he  was  informed 


124  MEDICAL    JURISPRUDENCE. 

that  the  other  had  the  incipient  signs  of  general  paresis,  and 
that  death  would  occur  in  three  or  four  years.  They  departed, 
and  the  result  was  that  a  policy  of  insurance  was  procured  for 
100,000  francs.  Three  years  afterwards  the  elder  brother 
quietly  pocketed  the  results  of  the  robbery. 

A  peculiar  case  is  reported  by  Le  Grand  du  Saulle.  A  physi- 
cian well  known  in  science  had  for  nine  years  before  his  death 
a  life  policy  for  ioc,ooo  francs.  He  suddenly  presented  the 
signs  of  great  cerebral  excitement,  became  boasting,  and  wrote 
and  spoke  in  an  exaggerated  manner.  He  again  went  to  the 
companies  and  insured  for  500,000  more.  When  the  contract 
was  prepared  and  ready  for  signature  the  manner  of  the  doctor 
was  so  vehement  and  excited  that  the  agent  believed  him  to  be 
drunk,  and  under  the  pretext  of  having  forgotten  to  insert  an 
indispensable  clause  took  back  the  policy.  Upon  the  following 
day  the  medical  man  was  sent  to  an  asylum,  and  six  months 
afterwards  died  of  general  paresis.  The  company  paid  to  the 
widow  the  100,000  francs  and  considered  itself  very  fortunate  in 
not  having  to  add  the  half  million  francs  the  husband  desired  to 
insure  for.    (See  Appendix  G.) 


Case  XXXIH. — Suicide,  Disputed  Policy  of  Insurance, 
Neglect  of  Insured  to  Answer  Question  in  Policy 
Regarding  Hereditary  Insanity — Verdict  for  Plain- 
tiff. 

Newton  ) 

vs.  >  76  N.  Y.,  426. 

Mutual  Benefit  Life  Ins.  Co.,  ) 

Henry  C.  Ross  had  effected  an  insurance  on  his  life  with  de- 
fendant and  subsequently  terminated  his  life  by  taking  a  dose 
of  laudanum  while  insane.  In  his  application  for  a  policy  he 
had  stated  that  no  member  of  his  family  had  been  afflicted 
with  insanity  or  other  herditary  disease,  but  stated  that  his 
father  had  died  of  a  brain  disease  caused  by  a  hurt.  On  the 
trial  it  was  proved  that  his  father  had  received  an  injury  on  his 
head  in  childhood  resulting  in  a  weakening  of  his  mental  powers, 
and  that  at  the  age  of  47  he  was  ])laccd  in  an  insane  asylum, 
and  afterwards  died.  On  this  testimony  plaintiff  was  non- 
suited, but  on  ai)peal  the  Court  of  Appeals  reversed  the  judg- 
ment of  non-suit  and  ordered  absolute  judgment  for  plaintiff. 


THE    LEGAL    RELATIONS   OF    INSANITY.  125 

Case  XXXIV, — Singular  Fraud  upon  Insurance  Com- 
pany, Murder  ;  Defense  of  Insanity  ;  No  Evidence 
However  of  its  Existence  ;  Acquittal. 

State  ) 

vs.  >  I  Houston's  Dela,  Criminal  Repts.,  373. 

Isaac  C.  West,  j 

Defendant  was  indicted  for  the  murder  of  a  negro  known  as 
"  Couch  "  Turner,  in  the  town  of  Dover.  It  appears  that  de- 
fendant was  experimenting  with  an  apparatus  for  the  manufac- 
ture of  a  peculiar  gas,  which  he  claimed,  if  inhaled,  would  cure 
several  kinds  of  diseases.  That  two  weeks  before  the  murder 
prisoner  rented  rooms  on  Loockerman  street,  Dover,  stating 
that  he  wished  them  for  a  short  time  only,  as  he  wanted  "  to 
do  enough  in  two  weeks  to  make  or  break  him."  That 
on  the  morning  of  December  2d  the  prisoner  engaged 
deceased,  who  was  a  stranger  to  him,  to  carry  a  box 
to  his  rooms,  and  that  deceased  had  not  since  been  seen 
alive.  That  between  11  and  12  p.  m.  of  the  next  day,  while 
in  the  Capital  Hotel,  prisoner  suddenly  left  saying  that  his 
retort  was  leaking  and  he  feared  an  explosion.  That  an 
hour  afterwards  his  rooms  were  discovered  to  be  on  fire,  and 
when  broken  into  the  mutilated  body  of  deceased  was  found, 
with  the  head,  hands  and  feet  severed,  and  saturated  with  coal 
oil.  On  the  5th  of  December  prisoner,  who  had  fled,  returned 
to  Dover  and  surrendered  himself  and  made  a  confession,  in 
which  he  said  that  after  he  had  paid  deceased  for  carrying  the 
box  he  offered  to  come  again  in  the  afternoon  and  fill  his  gaso- 
meter with  water  ;  that  he  met  deceased  on  the  street  in  the 
afternoon  and  brought  him  to  his  rooms,  preceding  him  up- 
stairs ;  that  after  he  arrived  in  the  room  he  turned  and  saw 
deceased  with  a  hammer  in  his  hand  and  the  deceased  de- 
manded his  money  or  he  would  kill  him  ;  that  he  then  picked 
up  a  piece  of  axle  and  deceased  struck  him,  crushing  his  hat. 
That  he  then  struck  deceased  on  the  neck,  killing  him  instantly. 
He  then  cut  off  the  head,  hands  and  feet,  and  skinned  the 
body  and  broke  several  of  the  bones  of  the  body.  He 
also  cut  the  nose  and  lips  from  the  head  and  then  crushed  it, 
to  prevent  recognition.  He  then  buried  the  head,  hands  and 
feet  and  saturated  the  skin  with  alcohol  and  lit  it  to  see  if  he 
could  thus  change  the  color  of  the  skin  ;  that  in  doing  this  he 
set  fire  to  the  premises  ;  that  he  then  left  town  but  returned 
the  next  day.     Also  that  his  life  was  insured  for  ^25,000.     It 


126  MEDICAL    JURISPRUDENCE. 

was  claimed  on  behalf  of  the  State  that  the  confession  that 
prisoner  had  endeavol-ed  to  change  the  color  of  the  skin  after 
mutilating  the  body,  and  then  firing  the  premises,  was  proof  that 
he  had  committed  the  murder  in  furtherance  of  a  conspiracy 
to  get  the  amount  of  insurance  on  his  life  ;  believing  that  the 
remains  would  be  mistaken  for  his.  On  behalf  of  defense 
insanity  was  urged  and  it  was  testified  that  prisoner's  father 
had  been  of  unsound  mind  for  three  months  in  1836  ;  that 
prisoner  had  had  several  falls  when  a  child  which  had  rendered 
him  unconscious  ;  that  in  1S69  he  walked  from  Baltimore,  one 
hundred  miles,  to  Dover  to  see  his  mother,  whom  he  had 
dreamed  was  ill  ;  that  in  the  summer  of  1872  he  had  washed 
two  cats  and  hung  them  in  a  basket  to  dry.  That  he  had 
made  a  collection  of  various  articles,  chiefly  of  no  value,  for 
the  purpose  of  forming  a  museum,  and  which  he  highly  prized, 
in  which  were  an  old  shoe,  an  old  umbrella  and  a  valuable 
frame  mirror.  That  in  packing  these  for  removal  he  had  care- 
fully wrapped  the  shoe  in  paper  and  a  sheet  while  the  mirror 
was  unprotected  and  consequently  badly  broken.  He  had  also 
attended  a  political  meeting  with  a  dog,  which  he  said  he 
intended  to  present  to  General  Grant.  He  had  driven  to  a 
meeting  on  one  occasion  and  in  the  course  of  two  and  a  half 
hours  had  got  in  and  out  of  his  carriage  twenty-five  or  thirty 
times  ;  he  appeared  each  time  to  do  something  to  the  horse  or 
harness  though  nothing  seemed  required  to  be  done. 

Several  witnesses  testified  to  his  general  unsoundness  of 
mind,  but  the  State  produced  a  number  of  witnesses  who  testi- 
fied to  a  long  acquaintance  with  him  and  who  had  never 
noticed  any  symptoms  of  an  unsound  mind. 

On  the  trial  the  jury  returned  a  verdict  of  "  Not  Guilty." 
This  verdict,  however,  may  have  been  given  on  the  ground  of 
self-defense. 

The  Legal  Status  of  the  Idiot.— Though  in  the  United 

States  the  idiot  is  deprived  of  his  civil  rights,  he  is,  curiously 
enough,  permitted  to  vote.  He  is  considered  incompetent  in  the 
matter  of  will-making  and  obligations  of  any  kind  contracted 
by  him  are  null  and  void  because  of  his  want  of  comprehension 
of  the  nature  of  these  acts.  He  is  also  considered  irresponsible 
criminally  when  it  can  be  shown  that  the  crime  is  motiveless 
and  unintentional  (in  their  legal  sense)  and  the  existence  of 
will  is  disproved.  In  these  cases  there  is  neither  realization  of 
punishment  nor  consequences. 

The  Kesponsihility  of  the  Deaf  and  Dumb. — The  mute 


THE    LEGAL    RELATIONS    OF    INSANITY.  I27 

was  at  one  time  considered  to  be  as  irresponsible  as  the  idiot, 
so  far  as  testimony  was  concerned  in  courts  of  law.  However, 
a  much  more  intelHgent  view  of  the  question  of  competency  of 
the  deaf  and  dumb  is  now  taken,  and  it  is  by  no  means  the  rule 
because  certain  channels  of  expression  which  put  the  individual 
in  communication  with  the  world  are  cut  off  that  he  is  entirely 
deprived  of  intelligence. 

Under  the  English  law  a  deaf  mute  is  not  incompetent  to 
give  evidence  unless  he  is  also  blind,  and  a  deaf  and  dumb 
person  who  has  had  no  education  or  instruction  cannot  be  held 
responsible  in  a  criminal  case  (Taylor). 

A  deaf  mute  who  enters  into  a  marriage  knowing  what  he 
does  and  assenting  by  signs  is  considered  responsible,  and  such 
a  contract  is  binding. 

Dr.  Peet,  who  has  had  very  wide  experience  with  the  deaf 
and  dumb,  gives  the  following  general  principles  in  regard  to 
their  rights  and  responsibilities  : 

"  A  deaf  mute  who  has  no  knowledge  whatever  of  written  lan- 
guages may  yet,  if  his  dialect  of  gestures  is  sufficiently  copious 
and  precise,  possess  the  intelligence  necessary  to  manage  his 
own  affairs,  to  make  all  civil  contracts,  to  execute  a  deed  or  a 
will,  or  to  give  evidence  in  a  court  of  justice. 

"  But  as  the  degree  qi  intelligence  and  of  moral  development 
in  uneducated  mutes  is  very  various,  some  who  have  been 
neglected  in  infancy  being  but  a  step  above  idiots,  they  should 
be  carefully  examined  to  ascertain  whether  they  really  possess 
the  necessary  degree  of  knowledge  and  intelligent  will. 

"  With  respect  to  the  formalities  used,  it  may  be  laid  down  as 
a  general  rule  that  the  deaf  mute  who  can  read  and  write  but 
imperfectly  or  not  at  all,  should  be  regarded  as  in  the  position 
of  a  German  or  Frenchman,  whose  ignorance  of  our  language 
necessitates  the  employment  of  a  sworn  interpreter  between  him 
and  the  court. 

"  But  when  the  deaf  mute  can  read  and  write  well,  the  best 
mode  is  that  prescribed  in  the  French  code.  In  the  case  of  such, 
reading  supplies  hearing,  and  writing  supplies  speech.  Hence  it 
follows  that  a  paper  presented  to  a  well  instructed  deaf  person 
calling  his  attention  jjy  pointing  with  the  finger  to  the  Avriting 
should  be  considered  as  read  to  him,  it  being  understood,  of 
course,  that  there  should  be  sufficient  light  and  sufficient  legi- 
bility of  writing.  We  think,  however,  it  ought  to  be  specially 
enacted  that  a  legal  service,  in  the  case  of  such  persons,  should 
consist  in  giving  them  a  copy  of  the  writ  or  notice  to  be  served 
informing  in  writing  of  its  nature  and  contents  ;  and  in  the  case 


128  MEDICAL    JURISPRUDENCE. 

of  deaf  mutes  who  cannot  read  or  but  imperfectly,  the 
reading  may  be  accomplished  by  the  aid  of  a  competent  inter- 
preter. Any  legal  oath  or  obligation  may  be  taken  or  assumed 
by  a  well  instructed  deaf  person  by  writing  out  with  his  own 
hand  the  formula  before  witnesses  with  such  forms  of  solemnity 
as  the  occasion  may  demand,  or  by  a  conversation  in  writing 
with  the  officiating  magistrate. 

"  It  should,  however,  be  generally  understood  that  many  of  the 
deaf  and  dumb  who  have  received  more  or  less  instruction  in 
our  schools  are  still  but  imperfectly  acquainted  with  written 
language,  and  that  signs  are  the  surest  and  readiest  means  of 
reaching  their  conscience  and  intelligence,  the  surest  means, 
also,  that  they  possess  for  explaining  their  own  meaning 
clearly.  *  *  *  *  And  before  the  criminal  as  well  as  be- 
fore the  civil  law  the  deaf  mute  has  the  same  rights  and  is  sub- 
ject to  the  same  accountability  as  his  brother  who  speaks  and 
hears.  *  *  *  *  'j'^g  ignorance  and  neglected  condition 
of  the  uneducated  deaf  mute  may,  however,  be  justly  urged  in  ex- 
tenuation of  his  faults,  as  an  appeal  to  the  compassion  of  the  court 
or  of  the  pardoning  power.  And  cases  may  occur  in  which  a 
deaf  person  has  acted  under  erroneous  impressions,  natural  in 
his  circumstances  as,  for  instance,  in  resisting  legal  process,  be- 
lieving it  to  be  unlawful  violence.  In  such  cases  there  is  evi- 
dently no  more  accountability  than  in  cases  of  hallucination. 

"  And  as  it  is  of  great  importance  to  every  man  whose  interests, 
liberty,  or  life  are  at  stake  in  a  court  of  law,  to  know,  as  they 
transpire,  the  proceedings  and  evidence  against  him,  we  think 
it  ought  to  be  made  a  rule  that  in  all  such  cases  an  intenpreter 
should  be  assigned  to  the  deaf  mute  who  will  keep  him  ad- 
vised of  at  least  all  the  important  points  in  the  proceedings,  by 
writing,  or  by  the  manual  alphabet  and  signs  according  as  the 
one  or  the  other  mode  is  the  more  clearly  intelligible  to  the 
prisoner." 


XXXV. — Murder  by  a  Deaf  Mute — Acquittal  by  Reason 
OF  Irresponsibility. 

State         ) 
vs.  y      I  Houston's  Dela.  Crim'l  Reports,  291. 

Jesse  Draper,  ) 

Defendant  was   indicted   for  the  murder   of  Nathaniel    H. 
Dickerson,  and  pleaded  not  guilty.     The  evidence  showed  that 


THE    LEGAL   RELATIONS   OF    INSANITV. 


129 


prisoner  was  a  negro,  aged  thirty,  deaf  and  dumb  from  birth, 
and  had  been  employed  for  seven  years  by  the  father  of 
deceased  ;  that  he  was  strong  and  powerful,  and  of  a  very 
violent  temper  at  times  ;  he  had  always  evinced  a  strong  parti- 
ality for  all  of  the  family  except  deceased,  who  was  the  only 
one  who  could  subdue  him  when  he  was  violent  ;  that  on 
November  9,  1867,  while  returning  from  Georgetown  in 
company  with  deceased  and  others,  he  was  ordered  by  de- 
ceased to  get  out  of  the  cart  in  which  they  were  riding.  He 
got  out  and  became  very  violent ;  shook  his  fist  at  deceased, 
who  jumped  from  the  cart  and  grappled  with  him  ;  he  then 
stabbed  deceased  with  a  pocket  knife  fifteen  times,  killing  him. 
(It  was  proved  that  prisoner  had  been  seen  sharpening  this 
knife  two  days  prior  to  the  murder,  and  that  he  had  shown  it 
to  parties  to  see  how  sharp  it  was,  and  had  flourished  it  as  if 
cutting  some  one.)  It  was  also  shown  that  prisoner  was  pos- 
sessed of  considerable  intelligence  and  mechanical  ingenuity  ; 
was  able  to  make  himself  well  understood,  although  he  had 
never  learned  the  language  of  mutes  ;  he  was  a  good  work- 
man ;  knew  the  boundaries  of  the  land  in  the  vicinity  better 
than  the  owners  ;  knew  the  value  of  our  coins  and  bank  notes  ; 
he  believed  in  future  reward  and  punishment,  although  he 
never  received  any  religious  instruction  ;  knew  and  understood 
the  punishment  for  crime.  His  previous  character  had  been 
good.  After  the  commission  of  the  murder  he  seemed  to  exult 
over  it,  although  he  was  conscious  of  what  he  had  done. 

On  the  trial  the  jury  returned  a  verdict  of  not  guilty  by  rea- 
son of  insanity,  or  want  of  criminal  responsibility. 

Criminal  Responsibility. — The  question  of  responsibility 
in  criminal  cases  is  one  worthy  of  the  closest  study.  We  are 
not  to  consider  the  subject  in  any  sentimental  manner,  nor  to 
build  up  a  flimsy  and  Utopian  theory  with  which  to  excuse  those 
in  whom  it  is  difficult  to  find  marked  phases  of  intellectual  de- 
generation— in  other  words,  the  classical  evidence  of  disease. 
The  moral  element  is  one  of  difiiculty. 

In  the  words  of  Bucknill :  * 

"  If  the  speculations  of  the  school  or  closet  lead  us  to  the 
belief  that  insanity  may  sometimes  occur  through  the  domina- 
ting power  of  a  mental  habit,  without  the  intervention  of  disease, 
such  opinion  will  be  found  foreign  to  the  practical  questions  to 
be  decided  in  courts  of  criminal  justice.  However  interesting 
it  may  be  to  the  psychologist  to  trace  the  growth  of  a  vicious 

*  Bucknill — Criminal  Lunacy,  p.  20. 


I^o  MEDICAL    jUKiSPRUDENCE. 

indulgence  in  some  passion  or  instinct  through  all  the  grada- 
tions of  mental  habit,  until  he  feels  himself  justified  in  denomi- 
nating the  result,  a  state  of  insanity  ;  he  must  not  forget  that 
in  the  trials  of  criminals  supposed  to  be  insane,  the  question  is 
not  alone  respecting  the  existence  of  insanity,  but  respecting 
that  of  irresponsibility  also.  The  man  who  would  claim  for  a 
criminal  exemption  from  punishment  on  the  plea  of  insanity, 
arising  from  the  vicious  and  uncontrolled  indulgence  in  some 
passion  or  emotion,  would  have  to  establish  not  only  the  ex- 
istence of  such  a  form  of  insanity,  but  to  defend  two  other 
positions,  namely,  that  a  man  is  not  responsible  for  conduct  re- 
sulting from  vicious  habits  of  mind,  provided  the  latter  gain 
over  him  a  complete  mastery,  and  compel  him,  contrary  to  all 
dictates  of  prudence,  to  actions  injurious  to  society  and  ruinous 
to  himself.  And  secondly,  that  neither  the  fear,  nor  the  inflic- 
tion of  punishment,  will  prove  efficacious  in  preventing  the 
repetition  of  such  acts. 

"  It  would  be  a  puerile  employment  to  show  the  untenable  na- 
ture of  such  positions,  and  it  must  suffice  to  express  in  this 
place  our  conviction  that  insanity  resulting  solely  from  vicious 
habits  of  mind  without  disease,  cannot  confer  irresponsibility 
for  criminal  acts  ;  and  that  punishment,  or  more  properly  speak- 
ing, corrective  discipline,  is  competent  to  restrain  its  mischiev- 
ous manifestations. 

"  Cicero  says  that  all  fools  are  insane  ;  and  Hale,  that  all 
criminals  are  insane  ;  and  when  folly  and  criminality  have 
reached  their  climax  and  borne  their  fruits,  it  is  not  an  edifying 
spectacle  to  behold  the  psychological  physician  stepping  for- 
ward for  the  purpose  of  claiming  immunity  for  the  offender. 

"  The  element  of  disease,  therefore,  in  abnormal  conditions  of 
mind  is  the  touchstone  of  irresponsibility,  and  the  detection  of 
its  existence  or  non-existence  is  the  peculiar  and  oftentimes  the 
difficult  test  of  the  psychopathist." 

Responsibility  in  Relation  to  Imbecility.— In  determ- 
ining the  responsibility  of  an  imbecile  we  are  to  inquire  into  the 
circumstances  of  the  crime,  as  well  as  his  education,  and  his  pre- 
vious life.  In  regard  to  the  first,  we  are  to  determine  whether 
there  has  been  any  attempt  at  secrecy,  or  whether  he  has  been 
regardless  of  consequences,  his  explanation,  the  method  of  the 
execution  of  the  act  of  violence,  and  his  behavior  after  the 
commission.  If  a  person  of  low  intelligence  and  depraved 
morals  (his  propensities  from  his  earliest  years,  as  the  result  of 
cerebral  disease,  being  bad)  commits  a  crime,  more  or  less  pur- 


THE  Legal  relations  ok  insanitv.  131 

poseless,  or  at  best  with  slight  motive,  perhaps  a  murderous 
assault  without  sufficient  provocation;  if  such  a  crime  is 
attempted  or  accomplished  without  any  concealment,  and 
boasted  about  ;  there  would  at  least  be  the  suspicion  aroused 
that  a  degree  of  irresponsibility  existed. 


Case  XXXVI, — Assault  by  an  Imbecile — Motiveless  act,, 
Conviction. 

Johnson    ) 

vs.         >■  10  Texas  Appeal  Reports  571. 
The  State,  ) 

Defendant  was  tried  for  an  assault  with  intent  to  murder  I. 
H.  Daniels,  and  convicted.  On  the  evening  of  Dec.  7,  1880, 
while  Daniels  was  entering  his  home  in  Grand  View  he  was  shot 
in  the  back  by  the  prisoner.  He  immediately  turned  around 
and  struggled  with  the  prisoner  who  escaped,  uttering  a  sound 
resembling  the  bark  of  a  dog,  but  was  arrested  the  next  day. 
He  was  a  stranger  in  the  neighborhood  and  no  motive  was 
shown  for  the  act.  He  had  frequently  been  known  to  get  up 
during  the  night,  when  asleep,  and  on  the  night  of  the  shooting 
was  very  uneasy.  Dr.  Young,  who  had  known  him  for  some  time 
believed  him  to  be  imbecile,  but  not  insane,  while  Dr.  Keating 
who  was  his  regular  physician,  positively  pronounced  him  insane. 
There  was  no  further  evidence  as  to  this  defense  except  that  of 
a  few  witnesses  on  the  part  of  the  State  who  believed  him  to  be 
sane. 

On  appeal  the  Court  of  Appeals  affirmed  the  convic- 
tion. 

There  are,  as  I  have  said,  many  individuals  who  know  the 
difference  between  right  and  wrong  and  yet  cannot  restrain 
their  tendency  to  the  latter.  Many  persons  consequently  fight 
against  their  impulses  and  many  partially  succeed  as  did  the 
old  lady  whose  case  is  referred  to  by  Casper.  Yet  their  reason- 
ing is  as  often  powerless. 

This  author  says:  "In  itself  this  case,  in  the  form  it  as- 
sumed at  the  period  of  our  examination,  was  one  of  daily  oc- 
currence, for  it  was  unquestionable  that  the  old  lady,  at  the 
time  sixty-eight  years  of  age,  a  sensible,  educated  woman  of 
pure  morals,  who  a  long  time  previously  had  been  judicially 
declared  to  l3e  '  imbecile,'  that  is  '  incapable  of  considering  the 
effects  of  her  actions,'  and  was  still  under  guardianship,  and 
the  effects  of  her  interdiction  which  she  was  endeavoring  to 
get  removed,  was  perfectly  restored,  and,  as  the  statutes  ex- 


132  MEDICAL    JURISPRUDENCE. 

presses  it,  had  re-attained  '  the  full  and  free  use  of  her  under- 
standing.' 

"  I  relate  this  case  here,  however,  because  it  gives  a  most  in- 
structive peep  into  the  interior  of  a  mind  under  the  trammels 
of  disease,  and  gives  from  a  credible  witness  a  confirmation 
of  the  well-known  psychological  experience,  that  those  mentally- 
diseased  may  not  only  have  a  dim  cognizance  of  the  difference 
between  good  and  evil  (vide  p.  no,  vol.  iv.),  but  also  that  even 
in  respect  of  this  obscure  consciousnes  they  can  command 
themselves  up  io  a  ce7'tain  point. 

"  The  discipline  of  every  lunatic  asylum  is  based  upon  the 
very  proper  recognition  of  this  fact  Our  convalescent  had 
gone  deranged  fifteen  years  previously,  and  had  remained  so 
many  years.  With  the  greatest  composure  she  communicated 
to  me  many  particulars  in  regard  to  her  derangement  and  its 
excesses,  describing  with  the  utmost  distinctness  her  then  pro- 
cess of  ratiocination.  For  a  time  she  was  impelled  to  break 
panes  of  glass  with  stones.  But  she  knew  how  improper  this 
was,  therefore  she  threw  the  stones  carefully,  so  as  not  to  break 
the  glass,  but  if  this  happened,  then  she  rejoiced  at  it !  She  set 
about  tearing  her  paper  bed-screen;  but,  as  she  found  it  abun- 
dantly replaced,  she  came  to  the  conclusion  that  this  was  done 
intentionally  to  keep  her  from  destroying  more  valuable  articles, 
therefore  she  left  off  tearing  the  screen.  Similar  tendencies  and 
similar  logic  were  exhibited  in  many  other  proceedings,  and 
she  could  not  sufficiently  describe  to  me  how  puzzling  to  her 
now  seemed  the  reasoning  which  then  seemed  clear  to  her. 
Similar  statements  are  made  every  day  by  insane  people,  who 
have  become  truly  restored;  but  similar  confessions  to  these  in 
respect  of  individual  minor  traits,  are  not  so  frequent." 

The  English  Test  of  Respoiisihility.— The  English  law  in 
brief  is  that  the  criminal  cannot  be  held  responsible  if  at  the 
time  of  the  commission  he  was  incapable  of  distinguishing  right 
from  wrong,  and  did  not  then  know  that  the  act  was  an  offense 
against  the  laws  of  God  and  Nature.  If  on  the  contrary  he 
was  capable  of  distinguishing  right  from  wrong,  then,  although 
the  delusion  may  be  connected  with  the  crime,  and  its  basis — 
the  person  committing  the  act  of  violence  in  revenge  for  imagin- 
ary injury — if  the  person  has  capacity  to  know  that  lie  has 
committed  an  illegal  act  he  is  fully  responsible.  The  real 
knowledge  of  the  difference  between  right  and  wrong  has  been 
the  test  for  years,  yet  it  is  not  sufficient.  The  charge  of  Lord 
Deas  of  Aberdeen  is  as  follows:  "  i.  If  a  man  knows  what  he 


THE    LEGAL    RELATIONS   OF    INSANITY.  I33 

is  doing — that  is  to  say,  if  he  knows  the  act  that  he  is  commit- 
ting— if  he  knows  also  the  true  nature  and  quality  of  the  act 
and  apprehends  and  appreciates  the  consequence  and  effect, 
that  man  is  responsible  for  what  he  does.  If  from  the  opera- 
tion of  mental  disease  he  does  not  know  what  he  is  doing — or 
if,  although  he  knows  what  is  the  act  he  is  performing,  he  can- 
not appreciate  it  or  understand  either  its  nature  or  quality — its 
consequence  or  its  effect,  then  he  is  not  responsible. 

"2.  If  the  jury  believed  that  the  prisoner,  when  he  committed 
the  act,  had  sufficient  mental  capacity  to  know,  and  did  know 
that  the  act  was  contrary  to  the  law,  and  punishable  by  the  law, 
it  would  be  their  duty  to  convict  him.  This,his  lordship  thought, 
was  a  safer  and  more  accurate  mode  of  putting  the  question 
before  the  jury  than  that  they  should  consider  whether  the  ac- 
cused knew  right  from  wrong."  (Ogston.) 

American  Decisions  in  Regard  to  Responsibility. — 

The  American  decisions  in  regard  to  criminal  responsibility 
are  practically  alike,  and  the  question  of  the  knowledge  of  right 
and  wrong  seems  to  be  that  to  be  decided  by  juries.  I  may 
quote  the  charge  of  two  American  judges: 

The  decision  of  Judge  Smith  in  the  Montgomery  trial  at 
Rochester  was  substantially  as  follows: — "There  is  now  no 
room  for  doubt  as  to  the  rule  of  law  in  this  State,  a  man 
must  have  sufficient  knowledge,  reason,  capacity  and  mental 
power  to  understand  not  merely  that  his  act  is  in  violation  of 
law,  but  that  it  is  intrinsically  wrong.  Every  human  being  en- 
dowed with  reason  knows  that  to  take  the  life  of  a  human  be- 
ing is  against  the  law  of  nature  and  of  God.  It  is  not  sufficient 
that  he  knows  the  thing  is  an  offense  against  human  laws,  but  he 
must  have  reason  and  capacity  to  know  that  he  is  not  only  vio- 
lating the  laws  of  man,  but  the  laws  of  God  and  nature." 

The  late  Recorder  Hackett  in  the  McFarland  case  charged 
the  jury  "  that  in  uttering  the  phrase,  '  state  of  insanity,'  I  am 
not  to  be  understood  throughout  as  meaning  thereby  the  state 
in  which  a  man  knows  the  act  he  is  committing  to  be  unlawful 
and  morally  wrong,  and  has  sufficient  reason  to  apply  such 
knowledge  and  to  be  controlled  by  it.  In  using  the  phrase, 
'state  of  insanity,'  I  am  to  be  understood  throughout  as  meaning 
the  state  under  which  a  man  is  not  accountable  for  an  alleged 
criminal  act  because  he  does  i2ot  know  that  the  act  he  is  com- 
mitting is  unlawful  and  morally  wrong,  and  has  not  reason 
sufficient  to  apply  such  knowledge  and  to  be  controlled 
by  it. 


134  MEDICAL    JURISPRUDENCE. 

*         *        *         To  constitute  a  crime,  the  accused  must  have 
been  acted  upon  by  motives  and  governed  by  will." 

The  Test  of  Right  and  Wrong.— It  is  a  very  difficult 
matter  sometimes  to  say  whether  the  alleged  lunatic  knows  the 
difference  between  right  and  wrong.  Unless  there  be  obvious 
insanity,  great  care  should  be  taken  in  answering  the  questions 
propounded  by  counsel.  This  is  a  question  for  juries  to  decide 
and  after  all  the  medical  man  can  only  say  that  he  considers 
the  patient's  mind  diseased.  "  It  is  sufficient,"  says  Haslam, 
"  for  the  medical  practitioner  to  know  that  the  person's  mind  is 
deranged,  and  that  such  a  state  of  insanity  will  be  sufficient  to 
account  for  the  irregularity  of  his  actions,  and  that  in  a  sound 
mind  the  same  conduct  would  be  deemed  criminal.  If  vio- 
lence be  inflicted  by  such  a  person  during  a  paroxysm  of  rage, 
there  is  no  acuteness  of  metaphysical  investigation  which  can 
trace  the  successions  of  thoughts,  and  the  impulses  by  which  he 
is  goaded  for  the  accomplishment  of  his  purpose." 

"Right  and  wrong"  are  relative  terms.  What  may  be  right 
in  one  community  may  be  wrong  in  another.  Browne 
says  :  "  There  is  no  right  and  wrong,  merit  or  demerit  existing 
independently  of  the  agents  who  are  virtuous  or  vicious."  The 
want  of  harmony  and  wide  diversity  of  opinion  for  example 
among  religious  bodies,  is  a  simple  example  of  how  difficult  it 
is  to  make  the  test  to  go  a  step  further.  It  has  been  proved 
as  I  have  shown  that  lunatics  know  the  consequence  of 
their  acts  and  the  penalties  prescribed  by  law.  The  true  test 
after  all  is  the 'condition  of  the  will. 

Mittermaier  maintains  "  that  two  conditions  are  required  to 
constitute  that  freedom  of  will  which  is  essential  to  responsi- 
bility, viz.,  a  knowledge  of  good  and  evil  and  the  faculty  of 
choosing  between  them.  The  knowledge  of  good  and  evil  will 
require,  first,  that  knowledge  of  one's  self  by  which  we  recog- 
nize our  personal  identity  and  refer  our  acts  to  ourselves. 
Secondly,  acknowledgment  of  the  act  itself,  /.  e.,  of  its  nature 
and  consequences  ;  thirdly,  a  knowledge  of  the  relation  of  the 
act  both  in  regard  to  men  and  measures  ;  fourthly,  a  knowl- 
edge that  the  act  in  question  is  i)rohil)ited  either  by  the  moral 
or  the  statute  law.  He  rel)ukes  the  English  jurists  for  their 
rigid  adherence  to  the  antiquated  doctrine,  that  whoever  can 
distinguish  good  from  evil,  enjoys  freedom  of  will  and  retains 
the  faculty  if  he  chooses  to  use  it,  of  framing  his  action  to  the 
requirements  of  the  law.  The  true  principle,  according  to 
(his  authority,  is  to  look  at  the  personal   character  of   the  indi- 


THE    LEGAL    RELATIONS   OF    INSANITY.  I35 

vidual  whose  responsibility  is  in  question.  To  his  grade  of 
mental  power  ;  to  the  notions  by  which  he  is  governed  ;  to  his 
views  of  things  ;  and  finally  to  the  whole  course  of  his  life  and 
the  nature  of  the  acts  with  which  he  is  charged.  A  person  who 
commits  a  criminal  act,  being  fully  cognizant  of  the  nature  of 
the  laws,  and  of  the  punishment  to  which  he  is  exposing  him- 
self, may  yet  be  of  insane  mind.  The  true  test  of  irresponsi- 
bility should  be,  not  whether  the  party  accused  was  aware  of 
the  criminality  of  his  action,  but  whether  he  has  lost  all  powej' 
of  control  over  his  actions." 

Ordonaux  on  RespOUSilbility. — Dr.  John  Ordonaux,  the 
well  known  writer  upon  the  legal  relations  of  insanity,  thus 
sums  up  the  questions  to  be  determined  in  relation  to  criminal 
responsibility  : 

"  First — Whether  the  defendant,  at  the  time  of  the  alleged 
crime,  knew  the  nature  and  consequences  of  the  act  he  was 
committing  ? 

"  Second — Whether,  if  he  did  so  know  them,  he  had  a  felo- 
nious intent  in  committing  the  act  ? 

"  Third — Whether,  knowing  the  nature  and  consequences  of 
the  act,  he  had  the  power  to  choose  between  doing  or  not  doing 
it? 

"  Fourth — Whether,  supposing  he  had  lost  the  power  of 
choosing  between  right  and  wrong  in  reference  to  the  particular 
act,  he  had  lost  that  power  through  disease^  and  not  through  in- 
toxication, violent  anger,  or  any  form  of  self-produced  mental 
convulsion  ? 

"  I  cannot  conceive  of  any  case  of  insanity  combined  with 
crime  to  which  these  questions  would  not  be  relevant.  They 
give  the  defendant  every  opportunity  of  showing  what  his  true 
mental  condition  was  at  the  date  of  the  offense,  and  at  the 
same  time  leave  no  loophole  through  which  simulators  can  es- 
cape detection  and  conviction. 

"  But  there  is  a  far  more  difficult  class  of  cases  to  deal  with 
than  these,  and  one  which  taxes  not  only  the  skill  of  experts, 
but  the  legal  wisdom  of  counsel  and  the  judicial  forbearance 
of  courts.  I  allude  to  those  cases  oi  paroxysmal  insanity  which 
never  come  into  the  field  of  judicial  investigation  without  giv- 
ing rise  to  much  unjust  criticism  upon  all  knowledge  of  mental 
disorder.  Thus  whenever,  upon  a  return  to  a  writ  of  ha- 
beas corpus,  a  party  is  discliarged  from  a  lunatic  asylum,  it 
seems  to  be  taken  for  granted  that  he  was  either  illegally  com- 
mitted there  or  improperly  detained  beyond  the  period  of  his 


I3O  MEDICAL   JURISPRUDENCE. 

established  convalescence.  Apart  from /i?;-;;/^  of  procedure  re- 
quired by  statute,  you  will  observe  that  both  the  above 
questions  involve  radical  problems  which  cannot  always  be 
easily  or  safely  decided  by  a  judge  at  chambers  after  a  short 
conversation  with  the  alleged  lunatic,  or  hearing  a  few  affidavits 
read  of  persons  who  have  made  quasi  medical  examination  of 
him  in  an  hour's  time.  Without  further  testimony  relating  to 
his  life,  habits,  conduct  and  conversation,  no  one  can  safely  un- 
dertake to  give  a  final  opinion  upon  his  mental  sanity. 

"  I  can  produce  any  day  a  hundred  lunatics,  selected  from 
our  various  asylums,  who,  if  they  were  placed  in  any  parlor  or 
office  and  engaged  in  general  conversation,  would  no  more  re- 
veal their  insanity  necessarily  than  they  would  their  religious 
convictions  or  their  parentage.  If  you  were  asked  to  state 
under  oath  what  your  opinion  of  such  person's  sanity  was,  you 
would  feel  almost  ashamed  to  doubt  it  for  fear  of  casting  im- 
putation upon  your  own.  Yet  these  people  are  lunatics,  and 
need  hospital  treatment.  You  think  they  are  well  because  they 
are  not  in  an  actual  paroxysm  of  their  malady,  but  they  are 
just  as  much  within  its  grasp  as  a  man  with  tertian  ague  is 
within  the  grasp  of  his  disease  on  his  well  days.  Insanity,  like 
all  the  neuroses,  is  a  disease  characterized  by  intermittent  exa- 
cerbations, and  while  in  its  intervals  its  victims  may  seem  per- 
fectly restored  to  the  eyes  of  casual  observers  ;  experts  know 
but  too  well  the  unreliability  of  any  opinion  based  on  a  per- 
sonal examination,  when  not  accompanied  by  a  complete  histo- 
ry of  the  patient's  past  life." 

Impulsive  Insanity. — Impuhivc  insanity  is  often  urged  as 
a  criminal  defense.  I  cannot  believe  that  any  individual  can 
be  sane  immediately  before  and  immediately  after  the  commis- 
sion of  an  act  and  insane  at  the  instant.  A  well  known  writer 
thus  expresses  himself  : 

"  I  see  no  ground  on  which  to  rest  an  hypothesis  of  an  im- 
jjulsive  insanity,  or  to  justify  an  incorporation  in  our  medical 
jurisprudence  of  such  a  form.  I  cannot  conceive  of  a  homi- 
cidal act,  impulsive,  without  motive,  delusion,  or  passion,  sim- 
ply a  so-called  impulse  to  kill,  and  a  careful  analysis  of  clinical 
cases,  under  my  own  observation,  as  well  as  a  large  ex])erience 
in  the  examination  of  criminals,  sustains  this  view.  Impulsive 
disease  can  not  exist.  The  term  impulse  used  to  describe  cer- 
tain acts  of  the  insane,  executed  suddenly,  and  without  a])pa- 
rent  premeditation,  maybe  proper  enough,  as  qualifying  a  men- 
tal state  during  an  act,  as  imj^ulsivc  homicide,  but  this  does  not 


THE    LEGAL    RELATIONS  OF    INSAiNTlY.  I37 

justify  the  transposition  into  homicidal  impulse.  Such  trans- 
jjosition  would  show,  not  that  the  acts  were  apparently  unpre- 
meditated and  sudden,  but  that  in  the  mind  there  was  suddenly 
generated  a  murderous  impulse,  an  irresistible  power,  which, 
without  the  intervention  of  reason,  or  any  intellectual  act  or 
motive,  suddenly  impels  to  the  physical  act.  Man  is  not  the 
prey  of  blind  impulse." 

The  annals  of  the  New  York  courts  are  filled  with  instances 
of  so-called  emotional  or  paroxysmal  insanity.  The  cases  of 
Cole,  MacFarland  and  Scannell,  are  familiar  to  many  of  our 
readers  and  it  only  remains  for  me  to  call  attention  to  the  utter 
flimsiness  of  the  so-called  evidence  of  insanity  produced  by  in- 
genious lawyers  and  desperate  friends. 


Case  XXXVII. — Major  General  George  W.  Cole  was  tried  in 
the  city  of  Albany  in  the  year  1868  for  the  murder  of  L.  Harris 
Hiscock,  who  seduced  the  wife  of  the  former.  In  this  case  the 
social  position  of  both  parties  greatly  increased  its  interest  and 
caused  much  excitement  throughout  the  state  ;  after  much 
trouble  in  procuring  the  jury  the  facts  of  the  homicide  Avere  de- 
tailed. On  the  evening  of  the  4th  of  June,  1867,  Hiscock  was 
standing  in  front  of  Stanwix  Hall  talking  to  two  friends.  The 
defendant  Cole  meanwhile  entered  the  hotel  through  a  side 
door,  and  advanced  rapidly  to  where  Hiscock  was  standing,  and 
placing  a  Derringer  pistol  within  a  few  inches  of  the  victim's 
head,  fired,  killing  him  instantly. 

The  defense  in  this  case  was  emotional  insanity,  and  after  an 
eloquent  speech  by  Mr.  Hadley  the  counsel  for  the  defense,  a 
number  of  medical  witnesses  were  called  to  prove  the  condition 
of  the  prisoner's  body  and  mind  previous  to  the  murder.  Dr. 
Manly  who  had  been  in  the  army  with  the  defendant,  Dr. 
Roberts,  and  others  testified  to  the  fact  that  the  prisoner  had 
had  an  injury  to  the  bowels,  with  hemorrhage  ;  that  he  was  de- 
pressed and  gloomy  and  suffered  from  "  bilious "  troubles. 
The  evidences  of  mental  disease  detailed  by  these  gentlemen 
were  instanced  :  as  constant  whittling  while  in  the  field,  of  lockets, 
and  rings  and  other  perishable  little  ornaments  of  no  conse- 
quence, absent  mindedness,  "  cheerful  "  when  he  was  well  and 
dejected  and  melancholy  when  he  was  sick.  One  witness  tes- 
tified that  he  had  melancholia  "  and  melancholy  and  klepto- 
mania are  about  the  same  thing."  Another  witness  testified  that 
if  one  person  should  suddenly  come  upon  another  who  was 
alleged  to  be  the  seducer  of  his  wife  he  would  be  very  likely  to 


I^S  MEDICAL    JUKISPKUDKNCE. 

take  his  life,  and  he  further  stated  that  such  would  be  an  in- 
sane act.  He  further  stated  that  bleeding  at  the  nose,  which 
was  a  frequent  occurrence  with  the  prisoner,  indicated  com- 
pression of  the  brain.  Most  of  the  other  testimony  for  the  de- 
fense was  of  Hke  character,  and  it  appeared  that  the  prisoner 
though  physically  disabled  as  the  result  of  his  honorable  service 
in  the  field,  presented  no  evidences  of  mental  disturbances  other 
than  those  any  individual  in  his  right  mind  would  display  if 
outraged  in  the  same  way  that  the  prisoner  was.  Many  wit- 
nesses testified  for  the  prosecution  that  the  prisoner  before  the 
homicide  seemed  to  be  in  his  right  mind  ;  took  interest  in  his 
business,  appeared  robust  and  in  good  spirits,  and  while  in  the 
army  did  not  impress  any  of  his  comrades,  except  the  one  who 
testified,  that  he  was  at  all  out  of  his  mind.  The  cowardly 
commission  of  the  murder  in  this  case,  its  deliberate  execution 
and  his  subsequent  behavior,  were  incompatible  with  actual  in- 
sanity or  at  any  rate  with  "paroxysmal  insanity."  It  is  almost 
unnecessary  to  add  that  as  a  result  more  of  the  eloquence  of 
the  late  James  T.  Brady  and  others,  than  any  thing  else,  the 
prisoner  was  acquitted. 

This  case,  as  well  as  all  others,  is  an  example  of  the  difficulty 
of  conviction  in  murders  prompted  by  motives  of  revenge  as  a 
consequence  of  the  alienation  of  a  wife's  affections,  and  so  long 
as  the  present  state  of  chivalrous  sympathy  (?)  exists  we  may  be 
prepared  to  find  the  defense  of  emotional  or  paroxysmal  insan- 
ity a  sufficient  one. 

Judge  Parker  in  the  Cole  case  instanced  no  less  than  eight 
examples  where  men  have  taken  the  law  in  their  hands 
and  have  been  acquitted  under  these  circumstances.  The  last 
and  most  farcical  example  of  acquittal  by  reason  of  emotional 
insanity  is  that  of  the  Kentucky  Congressman,  whose  mind 
appears  to  have  been  in  such  an  unstable  condition  that 
the  unfounded  suspicion  of  his  wife's  infidelity  was  sufficient 
to  produce  paroxysmal  insanity,  though  the  evidence  clearly  in- 
dicated deliberate,  premeditated  murder. 

Case  XXXVIII. — Emotional     Insanity — Murder     of     a 
Wife's    Paramour — Conviction. 

Anthony  Clark,      ) 

vs.  >      S  Texas  Court  of  Appeals,  Rpts.  350. 

State,  ) 

The  prisoner  was  tried  for  the  murder  by  shooting  of  Gabe 
Leonard  on  March  2,  1878,  having  obtained  a  confession  from 


THE    LEGAL    RELATIONS    OF    INSANITY. 


139 


his  wife  that  said  Leonard  had  been  intimate  with  her.  There 
was  no  controversy  over  the  corpus  delicti  and  the  principal  de- 
fense made  was  insanity  created  by  jealousy.  There  was  no 
attempt  made  to  prove  insanity  either  before  or  after  the  mur- 
der but  the  defense  rested  on  the  testimony  that  defendant 
was  a  good  husband  and  an  industrious  man,  and  several  citi- 
zens gave  him  an  excellent  character  generally. 

The  prisoner  was  found  guilty  of  murder  in  the  second  de- 
gree and  this  was  affirmed  by  the  Court  of  Appeals. 


Case    XXXIX. — Murder — Trumped   up   Defense  of    In- 
sanity— Conviction. 

State  ) 

vs.  \      8  Missouri  Appeal  Repts.  i. 

Redemeier,      ) 

The  defendant  was  convicted  of  murder  of  Franz  Vosz,  a 
stone-mason  in  North  St.  Louis,  whom  he  without  provocation 
shot  dead.  The  defense  pleaded  insanity.  There  was  no 
proof  that  prisoner  had  ever  been  considered  insane  prior  to 
the  shooting;  but  defense  claimed  that  the  incidents  surround- 
ing the  shooting  and  the  fact  that  no  motive  for  the  act  was 
shown  were  proof  of  prisoner's  insanity.  Several  witnesses  tes- 
tified that  the  prisoner  had  stated  to  each  of  them  different 
motives,  some  of  them  very  absurd,  for  committing  the  crime, 
and  each  of  these  motives  was  shown  to  conflict  with  the  facts. 
He  seemed  to  have  no  conception  of  the  crime  he  had  com- 
mitted. Several  witnesses,  among  them  his  own  mother,  testi- 
fied that  they  knew  him  for  years  and  had  never  observed  any 
symptoms  of  a  deranged  intellect  in  him.  About  two  years 
before  the  murder  deceased  had  refused  to  include  prisoner  in 
an  invitation  to  drink  with  him  but  it  was  not  shown  that  de- 
fendant exhibited  any  anger  on  that  occasion.  Beyond  this  no 
motive  was  attempted  to  be  shown.  Three  experts  were  ex- 
amined, one  of  whom  believed  that  a  taint  of  insanity  was 
present  in  the  prisoner  ;  this  opinion,  was  based  on  a  personal 
examination.  The  other  two  experts,  from  hypothetical  cases 
based  on  the  facts,  believed  the  prisoner  to  be  sane. 

On  appeal  to  the  St.  Louis  Court  of  Appeals  the  conviction 
was  affirmed. 

In  this  case  after  the  prisoner  was  hung  an  attempt  was  made 
to  show  that  his  brain  was  that  of  an  imbecile. 


140  MEDICAL    JURISPRUDENCE. 


Case  XL. — Wife  Murder — Defense  of  Insanity — Doubt- 
ful Evidence — Conviction. 

Sayres  ) 

vs.  >  88  Pa.  St.,  291. 

Commonwealth,  ) 

Prisoner,  in  1875,  having  had  some  difficulty  with  his  wife, 
threw  her  down-stairs  and  broke  her  arm,  for  which  he  was 
sentenced  to  imprisonment,  but,  after  a  short  time,  upon  her 
solicitation,  he  was  released,  although  she  refused  to  live  with 
him  again.  After  his  release  he  made  several  unsuccessful 
attempts  to  induce  her  to  take  him  back.  On  Sunday,  Novem- 
ber 18,  1877,  the  prisoner  followed  his  wife  into  church  and  at 
the  conclusion  of  the  services  shot  her  in  the  back.  He 
attempted  to  escape,  but  when  arrested  made  no  resistance, 
and  complained  of  a  pain  in  the  head.  Mrs.  Sayres  died  Nov. 
29th.  It  was  proved  that  prisoner  was  impoverished  while  his 
wife  was  in  good  circumstances,  and  a  motive  thus  shown  for 
his  wishing  to  live  with  her.  The  fact  of  the  shooting  was  not 
seriously  disputed.  The  defense  was  insanity,  and  it  was 
attempted  to  show  that  deceased  had  said  after  the  shooting, 
"  My  husband  shot.me,  but  I  don't  want  him  punished,"  to  show 
that  she  knew  he  was  insane.  This  was  very  properly  ruled  out. 
(On  appeal  the  Supreme  Court  sustained  this  ruling.)  It  was 
shown  that  several  blood  relations  of  the  prisoner  had  been 
afflicted  with  mental  disease  ;  a  sister  was  weak-minded  ;  a 
niece  subject  to  fits  ;  a  cousin  born  an  idiot.  One  witness 
testified  that  prisoner  was  queer,  of  peculiar  habits.  Another 
that  he  was  "  as  crazy  as  a  bed-bug  ;"  that  his  brain  was  shat- 
tered ;  others  that  he  cried  because  his  hands  were  stained  ; 
gave  strange  answers  to  questions  ;  was  afraid  to  sit  alone  ;  he 
supposed  his  wife  and  children  had  poisoned  him  ;  was  nervous 
and  could  not  sleep  ;  complained  of  his  head  ;  was  afraid  of  a 
dog  or  cat.  Another  witness  testified  to  his  conduct  for  a 
week  preceding  the  shooting — his  eyes  were  wild  ;  threw  meat 
on  the  floor,  and  preserves  on  the  table.  Dr.  Wise,  who  exam- 
ined him,  believed  him  to  be  of  unsound  mind.  To  controvert 
this  the  physician  of  the  prison  in  which  he  was  placed,  two 
keepers  and  the  officers  who  arrested  him.  all  believed  him  to 
be  sane  at  the  time  of  his  arrest.  Others  who  were  associated 
with  him  in  business  testified  to  their  belief  in  his  mental 
soundness.  Others  testified  that  he  liad  said  "  that  his  life  was 
miserable  and  unpleasant,  but  that  was  no  excuse  for  the  shoot- 


THE    LEGAL    RELATIONS    OF    INSANITY,  I4I 

ing,"  and  that  "not  being  allowed  to  visit  them  (his  children) 
was  the  cause  of  his  shooting  her."  Several  letters  and  a  will 
of  the  prisoner  were  also  produced  to  prove  his  sanity. 

On  the  trial  he  was  convicted  of  murder  in  the  first  degree 
and  on  appeal  to  the  Supreme  Court  the  conviction  was 
affirmed. 


Case  XLI. — Homicide  by  Alleged  Lunatic — Histokv 
Simply  of  Hypochondriasis — Motive  Revenge — Pris- 
oner Convicted,  eut  Conviction  Reversed  on  Appeal. 

Levi  King  ) 

vs.         [-9  Texas  Appeal  Repts.,  515. 
The  State,  ) 

The  prisoner,  on  March  22,  1880,  shot  and  killed  Dr.  H.  W. 
Harrington.  On  the  trial  it  appeared  that  Harrington  levied 
on  some  property  of  the  prisoner  for  debt,  and  that  prisoner 
had  threatened  vengeance  upon  him  therefor.  After  the  shoot- 
ing the  prisoner  stated  that  he  had  first  been  assaulted  by  de- 
ceased, but  when  it  was  shown  to  him  that  such  was  not  the 
case,  he  appeared  confused,  but  gave  no  other  explanation. 

For  the  defense  it  was  claimed  that  the  prisoner  was  suffering 
from  masturbation,  which  produced  hallucinations.  It 
was  testified  that  for  three  years  before  the  murder  he  would 
occasionally  leave  home  and  wander  through  the  woods  ;  that 
he  was  while  under  these  spells  dull  and  sleepy  ;  that  he  claimed 
he  was  a  ruined  man  ;  neglected  his  business  ;  and  several  wit- 
nesses testified  on  general  impressions  both  for  and  against  the 
insanity  theory. 

The  prisoner  was  convicted  ;  but  on  appeal  to  the  Court  of 
Appeals  the  conviction  was  reversed. 


Case  XLH. — Murder — Defense  of  Insanity — Hereditary 
Tendencies  Proven,  but  Nothing  Else — Motive  for 
Crime — Conviction. 

Webb      ) 
vs.         \  9  Texas  Appeal  Repts.,  490. 
The  State,  ) 

On  September  2,  1876,  in  the  city  of  Galveston,  defendant 
shot  and  killed  Charles  R.  Foster,  and  was  tried  and  convicted 
of  murder  in  the  second  degree.  It  appeared  in  evidence  that 
Faster  had  garnisheed  some  money  of  defendant  for  debt  and 
that  he  had  said  that  "  Foster  had  better  hunt  his  coffin  before 


t42  MEDICAL    JURISPRUDENCE. 

he  tried  to  collect  that  debt."  After  the  shooting  the  prisoner 
appeared  somewhat  excited,  but  made  no  attempt  to  escape, 
although  he  had  ample  opportunity  to  do  so.  He  finally  sur- 
rendered himself  to  an  officer  ;  he  was  then  very  indiffierent 
and  manifested  annoyance  when  questioned  about  the  murder. 
A  brother  and  cousin  of  prisoner  testified  that  his  mother  is 
insane  ;  his  grandfather  was  insane  and  committed  suicide  as 
also  did  a  cousin  who  was  insane.  His  sister  was  subject  to 
epileptic  fits  ;  his  father  was  very  eccentric  ;  none  of  these 
persons  had  ever  been  sent  to  an  asylum.  That  on  the  night 
before  the  murder  the  brother  met  prisoner,  who  had  been 
away  from  home  for  three  weeks,  and  it  was  several  minutes 
before  he  (prisoner)  recognized  him.  His  manner  for  some 
time  before  the  shooting  was  strange  and  unnatural,  and  he 
became  morose,  moody  and  careless  in  dress.  One  witness 
testified  that  after  the  shooting  his  eyes  glared  and  he  looked 
so  unearthly  that  witness  became  frightened.  Drs.  Seeds  and 
Gibson,  who  had  heard  all  the  evidence,  believed  the  prisoner 
was  insane  when  he  committed  the  murder.  Dr.  Stone  would 
not  express  an  opinion  on  1'ie  evidence,  but  said  he  had  heard 
no  evidence  of  insanity  that  could  not  be  attributed  to  de- 
bauchery ;  he  believed  that  the  mind  of  defendant  was  dis- 
tracted at  the  time  of  the  murder,  but  not  enough  so  as  to  relieve 
him  from  responsibility.  Of  the  witnesses  of  the  shooting  (five 
in  number)  two  stated  that  they  saw  nothing  unusual  in  his 
appearance  ;  the  other  three  did  not  observe  his  appearance. 

On  appeal  to  the  Court  of  Appeals  the  conviction  was 
affirmed. 

Insanity  in  Relation  to  Tlieft. — Theft  may  be  com- 
mitted by  the  insane,  the  crime  being  in  some  respects  a  fea- 
ture of  the  early  stage  of  the  disease.  Six  patients  suffering 
with  general  paresis  who  were  admitted  to  the  West  Riding 
Asylum  during  a  period  of  four  years,  had  been  arrested  for 
larceny.  Browne  suggests  that  this  propensity  may  be  a  direct 
result  of  the  exalted  delusion. 

A  patient  with  general  paresis  who  had  delusions  of  great 
wealth,  believing  that  he  was  the  possessor  of  8,000  pounds,  and 
had  16,000  children,  was  convicted  of  larceny.  Shortly  before 
the  commission  of  the  theft  he  showed  his  first  symptoms  of 
general  paresis,  and  there  was  no  history  of  intemperance  or 
bad  habits — in  fact  he  had  been  a  respectable  man.  His  theft 
was  petty,  a  few  nuts  having  been  stolen. 

Theft  is  often  the   result  of  an  insane  delusion,  the  person 


THE  Legal  relations  of  insanitv. 


14: 


believing  tliat  the  stolen  articles  belong  to  him,  or  that  he  has 
been  commanded  by  God  or  some  one  else  to  take  them  for 
a  purpose.  The  nature  of  the  act  and  the  purpose  itself  should 
be  clearly  those  of  insanity  to  bring  irresponsibility. 

The  Commitment  of  Lunatics. — The  laws  regarding 
the  commitment  of  lunatics  are  practically  the  same  in  every 
State.  The  certificates  of  one  or  more  physicians  who  have 
examined  the  patient  are  required,  and  these  must  be  approved 
by  a  judge  of  one  of  the  higher  courts. 

State  Laws. — In  some  States  the  case  must  be  brought 
before  a  jury.  In  brief,  the  laws  of  the  different  States  are  as 
follows  : 

New  York. — Patient  to  be  examined  by  two  physicians  of  at 
least  three  years'  standing,  who  have  been  declared  Examiners 
in  Lunacy  by  a  judge  of  a  Court  of  Record.  Upon  certificates 
of  these  two  medical  men,  sworn  before,  and  approved  by  a 
judge  of  a  Court  of  Record,  the  patient  may  be  sent  to  an 
asylum.  The  approval  may  be  procured  at  any  time  within 
five  days. 

Maine. — Patient  to  be  examined  by  the  municipal  officers  of 
the  town,  upon  application  of  the  friends  of  the  patient  or  a 
Justice  of  the  Peace. 

Vermont. — Upon  the  certificate  of  two  physicians  residing  in 
the  probate  district  in  which  the  patient  lives,  who  shall  not  be 
members  of  the  same  firm,  the  patient  may  be  committed. 

In  Neiv  Hampshire,  upon  order  of  the  Court  or  a  Judge  of 
Probate,  based  upon  the  certificate  of  two  reputable  physicians 
whose  respectability  shall  be  vouched  for  by  the  Judge  of  the 
Supreme  Court  or  Court  of  Probate,  or  Mayor  or  Chairman  of 
Selectmen. 

In  Alassachiisetts,  upon  representation  of  the  friends  of  the 
patient  and  the  certificates  of  two  graduated  physicians  of  three 
years'  practice,  the  patient  is  committed  by  order  of  the  Court, 
after  a  personal  examination,  it  necessary. 

In  Rhode  Island,  the  certificates  of  two  physicians  of  good 
standing  are  required,  and  an  order  of  court  procured  at  the 
solicitation  of  the  guardian  or  friends. 

In  Connecticut  the  certificate  of  one  or  more  physicians  prop- 
erly acknowledged  by  some  officer  or  magistrate  authorized  to 
administer  oaths  or  take  acknowledgments  of  deeds  when  given, 
is  necessary. 

In  New  Jersey  the  patient  is  committed  at  the  request  of  a 
friend,  who   shall  present  a  certificate  signed  by  at  least  one 


144  MEDICAL    JURISPRUDENCE^ 

respectable  physician,  who  shall  declare  under  oath  that  the 
patient  is  insane. 

In  Pen?isylvania  two  certificates  are  required. 

In  Vz?'gi7iia  the  patient  must  be  brought  before  a  commission 
in  lunacy,  consisting  of  three  magistrates,  who  shall  summon 
the  family  physician  and  other  witnesses,  and  if  the  patient  is 
judged  insane  after  a  careful  examination,  he  is  sent  to  an 
asylum. 

In  Maryland  the  patient  may  be  committed  upon  the  cer- 
tificate of  one  physician. 

In  North  Caroli?ia,  upon  representation  of  some  respectable 
citizen,  sworn  to  before  some  justice  of  the  jieace  in  the  county 
in  which  the  patient  resides,  he  may  be  committed. 

In  Mississippi  the  patient  may  be  received  into  an  asylum 
upon  the  certificate  of  two  physicians  who  shall  swear  to  his 
insanity  before  a  justice  or  county  clerk. 

In  Alabama  patients  are  received  in  the  State  asylum  on  cer- 
tificate of  the  probate  judge  of  the  county,  attested  by  one  res- 
pectable physician  or  other  witnesses,  with  or  without  a  jury, 
as  the  judge  may  decide. 

In  Ohio  the  probate  judge  issues  a  warrant  for  the  produc- 
tion of  the  alleged  lunatic,  and  subpoenas  such  witnesses  as  he 
deems  necessary,  one  of  whom  shall  be  a  respectable  physician, 
and  upon  being  satisfied  of  the  insanity  of  the  person,  he  shall 
issue  a  certificate  of  commitment. 

In  Indiana,  the  insane  are  committed  by  two  magistrates, 
who  are  required  to  personally  visit  the  alleged  lunatic,  and  to 
report  to  the  county  clerk,  who  subpoenas  witnesses,  and  sends 
a  certified  copy  of  the  ])roceedings  to  the  Superintendent  of  a 
State  hospital,  requesting  admission. 

In  Illinois,  upon  petition  of  a  near  relative  of  tlie  alleged 
lunatic,  he  is  brought  before  a  jury  of  six  persons,  one  of  whom 
shall  be  a  pliysician,  and  upon  their  verdict,  a  committal  shall 
be  made  out  by  the  clerk. 

The  law  of  Michio;an  requires  that  the  probate  judge,  after 
calling  two  respectable  physicians  and  other  credible  witnesses 
shall  decide  upon  the  question  of  the  insanity  of  a  person  either 
with  or  without  a  iury. 

In  Kentucky  the  insane  are  committed  by  the  inquest  of  a 
jury,  their  presence  being  required  in  open  Court,  unless  it  is 
shown  upon  the  affidavit  of  two  respectable  physicians  that  it 
would  be  dangerous  to  bring  the  supposed  lunatic  into  Court. 

In  Io7va  the  i)atient  is  examined  by  a  permanent  commission 
of  lunacy   comjjosed  of    a   practicing  physician,   a    practicing 


THE    LEGAL    RELATIONS    OF    iNSANITY.  145 

lawyer,  appointed  by  tlie  Circuit  Judge,  and  a  clerk  of  the 
Court.  A  personal  examination  is  recjuired  to  be  made  by  the 
physician,  and  after  a  report  to  the  commission  a  conference  is 
held,  and  the  patient  committed  if  they  deem  him  insane. 

In  WisiOfisiii,  upon  the  certificate  of  two  physicians  the 
patient  is  committed  by  the  county  judge.  A  jury  trial  is  ac- 
corded if  requested  by  a  relative. 

In  A'linncsota,  the  probate  judge,  upon  aj^plication,  shall  ap- 
point some  physician  or  physicians  (not  less  than  one  nor  more 
than  three)  to  examine  the  person  and  to  take  proof,  and  upon 
their  certificates  a  warrant  of  commitment  shall  be  issued.  In 
the  city  of  St.  Louis  application  is  to  be  made  to  the  health 
commissioner,  who  shall  direct  an  examination  by  physicians, 
who  shall  request  his  commitment. 

In  Arkansas,  upon  application  of  any  reputable  citizen, 
any  county  or  probate  judge  shall  appoint  a  hearing,  take  tes- 
timony of  competent  witnesses,  and  shall  direct  an  examination 
of  the  alleged  lunatic  by  one  or  more  practicing  physicians  of 
good  standing,  who  shall  submit  a  sworn  statement  of  their 
examination,  upon  which  a  certificate  shall  be  issued. 

In  Texas,  upon  tlie  presentation  of  competent  testimony,  a 
patient  may  be  committed  by  a  jury  of  six  if  found  insane. 

In  California  and  Oregon,  upon  the  representation  of  either 
a  friend  of  the  patient,  or  two  householders,  and  upon  the  pre- 
sentation of  certificates  signed  by  at  least  two  respectable  phy- 
sicians, the  insane  patient  may  be  committed  by  an  order  of  the 
Court. 

The  laws  of  other  States  contain  practically  the  same  pro- 
visions. A  person  of  weak  mind  has  not  the  same  status  in  the 
eyes  of  the  law  in  civil  questions  as  in  criminal.  His  responsi- 
bility is  differently  gauged. 

Comniissio  de  Liiiiatico  Iiiqiiireiido. — In  civil  matters 

his  incompetency  may  be  so  great  as  to  suggest  protection. 
He  may  be  able  to  distinguisli  right  from  wrong,  and  have  suf- 
ficient intelligence  to  prevent  him  from  committing  crime,  but 
his  mental  condition  otherwise  may  be  such  as  to  incapacitate 
him  for  the  transaction  of  business,  and  the  management  of 
property.  In  this  case  he  is  afforded  a  protector  in  the  shape 
of  a  guardian,  after  the  process  of  the  appointment  of  a  com- 
mission de  lunatico  inquirendo.  A  guardian  who  shall  protect 
him  from  imposition  and  fraud,  and  who  shall  prevent  him  from 
squandering  his  money.  Not  only  is  such  a  step  taken  for  the 
protection  of  the  idiot  and  imbecile,  but  for  the  insane  and  con- 


146  MEDICAL    JURISPRUDENCE. 

firmed  drunkard.  The  application  for  such  a  guardian  is  to  be 
made  by  a  near  relative,  who  procures  the  affidavit  of  at  least 
two  physicians,  and  a  commission  of  three  members,  one  of 
whom  shall  be  a  physician,  and  the  other  a  lawyer,  shall  be  ap- 
pointed by  a  Judge  of  a  Court  of  Record.  The  case  is  then 
tried  before  a  jury*,  and  upon  their  verdict  a  guardian,  who 
must  give  bonds,  is  appointed  by  the  Court.  The  individual  is 
then  practically  a  minor.  In  the  event  of  his  recovery,  an  ap- 
plication for  the  restoration  of  his  ordinary  privileges  is  made 
upon  affidavits  of  physicians,  and  if  the  judge  is  satisfied  of  his 
sanity  the  guardian  is  discharged. 

Great  care  should  be  taken  in  giving  or  preparing 
testimony,  for  it  has  often  happens  that  the  reasons  assigned 
are  of  the  most  flimsy  character,  and  may  be  trumped  up  by 
designing  relatives,  and  too  readily  accepted  t)y  careless  medical 
men.  It  should  be  ascertained  whether  the  individual  has  been 
/;/i-«//^/>' extravagant — whether  he  has  been  swindled  repeatedly, 
or  drawn  into  absurd  speculations.  One  old  lady  whom  I  ex- 
amined, invested  two-thirds  of  her  small  fortune  in  bogus 
mining  companies  within  a  few  months,  and  spent  considerable 
sums  of  money  in  the  most  foolish  ways,  while  before  this 
time  she  was  penurious  and  economical.  It  is  often  neces- 
sary to  decide  the  question  whether  a  person  of  weak  mind 
should  be  detained  in  an  asylum  or  placed  in  charge  of  a  guar 
dian  and  permitted  to  live  outside  ;  and  the  courts  are  exceed- 
ingly lenient  in  such  matters,  being  especially  careful  in  regard 
to  the  possible  abridgment  of  personal  liberty.  The  cele- 
brated Dickie  case  was  one  of  this  kind,  and  though  the  medi- 
cal men  who  examined  the  patient  considered  her  an  insane 
person,  thus  placing  themselves  in  direct  opposition  to  the 
press,  their  view  of  tlie  case  was  disregarded,  and  Judge  Brady 
ordered  Miss  Dickie's  discharge,  but  appointed  a  guardian. 
The  following  interesting  and  truthful  account  of  the  case  ap- 
peared in  the  New  York  Times  : 


Case  XLVI. — "Miss  Dickie  was  sent  to  Bloomingdale  six 
and  a  half  years  ago  on  the  certificates  of  Dr.  White,  a  prominent 
homceopathist,  and  of  Dr.  Alfred  C.  Post.  She  was  accepted  as 
a  lunatic  by  Dr.  'I'ilden  Brown,  and  retained  as  such  by  Drs. 
Nicholl  and  McDonald,  with  the  imj^lied  consent  of  her  aged 
and  iml)ecile  father's  physician  and  guardian.  Dr.  Ranney.  It 
is  highly  improbable  that  she  was  unjustly  committed  and  con- 

*  In  llie  city  of  New  York  by  a  sheriff's  jury. 


THE  LEGAL  RELATIONS  OE  IMSANITY.         I47 

fined,  for  the  prestige  of  that  merciful  institution  is  too  great 
and  its  medical  staff  too  distinguished  to  allow  great  mistakes 
on  such  important  matters. 

"On  the  afternoon  of  January  16,  1878,  Miss  Dickie  was 
visited  by  a  physician,  who  gave  her  his  name  and  address, 
and  told  her  he  was  a  physician  who  had  come  to  see  her.  She 
was  found  to  be  diminutive  in  size,  lame,  and  apparently  de- 
formed, hard  of  hearing,  and  with  speech  very  indistinct  and 
imperfect  from  a  very  wretched  condition  of  her  gums,  teeth, 
and  mouth.  The  latter,  it  was  supposed,  could  easily  have 
been  relieved  by  careful  rinsing  and  washing  of  the  mouth. 
There  were  other  signs  of  carelessness  of  person  and  dress 
which  were  not  visible  in  the  persons  of  the  Matron,  attend- 
ants, and  other  patients  who  were  casually  observed. 

"  In  a  little  while  she  was  conversing  quite  freely  about  bad 
treatment  she  had  received  from  her  father,  who,  she  said, 
used  to  pull  her  hair  and  otherwise  maltreat  her  ;  of  deceit  on 
the  part  of  her  brother  and  sisters  ;  of  bad  treatment  on  the 
part  of  Dr.  Brown  and  others.  She  also  complained  of  the 
food  she  received  ;  among  others,  that  they  sometimes  had 
onions  for  dinner,  and  that  they  were  served  especially  to 
annoy  her.  She  also  asserted  that  she  had  been  promised  any 
kind  of  food  that  she  wanted.  She  stated  that  an  effort  was 
being  made  with  her  consent  and  that  of  her  family  to  remove 
her  from  the  asylum,  and  expressed  a  preference  to  live  in  the 
city  rather  than  in  the  country,  with  some  slight  hint  which 
suggested  that  she  did  not  like  green  things,  but  desired  to 
visit  shops,  go  to  her  own  church,  give  money  to  it,  and  live  by 
herself.  She  volunteered  to  say  that  she  read  the  Sun  and  the 
Observer,  and  showed  copies  of  them  ;  that  she  had  a  great 
impulse  to  improve  her  mind;  quoted  some  simple  little 
maxims  at  times,  especially  about  not  talking  too  much,  when 
she  was  monopolizing  almost  the  whole  conversation,  and  men- 
tioned with  great  glee  that  she  had  been  down  to  court,  but 
they  had  got  nothing  out  of  her,  which  I  supposed  meant  that 
she  had  not  committed  or  betrayed  herself.  She  also  insisted 
that  Dr.  Post  had  testified  in  her  favor,  and  reiterated  this 
statement  when  told  that  she  was  probably  mistaken.  As  she 
occasionally  quoted  Scripture,  she  was  asked  if  she  had  a 
Bible  ;  it  was  then  noticed  that  she  seemed  to  keep  almost  all 
her  property  under  lock  and  key,  but  she  quickly  produced 
her  Bible  from  a  locked  drawer,  and  it  was  found  not  only  filled 
with  pencil  marks  from  Genesis  to  Revelations,  but  many  pages 
were  folded  in  the  most  curious  and  complicated  ways,  as  if  to 


148  MEDICAL    JURISPRUDENCE. 

mark  special  passages  of  great  import  to  herself,  but  her  visitor 
was  surprised  on  unfolding  these  curiously  doubled-up  pages 
to  find  no  pencil  marks  whatever  upon  some  of  them,  and  she 
avoided  answering  why  she  thus  pointedly  singled  out  particu- 
lar pages.  It  is  barely  possible  that  those  were  pages  which 
she  did  not  wish  to  read,  but  nothing  could  be  detected  strik- 
ingly peculiar  in  the  contents  of  those  pages  upon  a  short 
examination. 

"  Her  first  visitor  had  been  alone  with  her  for  half  an  hour  or 
more,  when  another  physician  came  into  the  room,  was  intro- 
troduced  by  name  and  title  as  a  second  medical  man  who  had 
come  to  see  her.  She  immediately  went  on  conversing  with 
him,  and  the  first  party  looked  at  the  surroundings.  Her  room 
was  very  neat,  quiet  and  comfortable,  was  prettily  furnished 
with  a  blue  carpet,  blue  cottage  furniture  of  a  superior  kind. 
His  attention  was  attracted  by  hearing  her  tell  her  second  visi- 
tor that  there  was  a  language  of  food  as  well  as  of  flowers,  and 
when  asked  for  an  illustration  stated  that  coffee  was  brown, 
brown  was  a  Quaker  color,  a  Quaker  was  a  friend,  and  that 
hence  coffee  meant  friendship.  That  if  one  person  gave 
another  a  cup  of  coffee,  it  was  a  sign  of  friendship,  and  if  milk, 
which  was  white,  was  put  into  it,  it  was  a  sign  of  pure  friend- 
ship, and  the  addition  of  sugar  made  it  an  indication  of  sweet 
friendship.  In  short,  that  coffee  with  milk  and  sugar  in  it  was 
indicative  of  pure,  sweet  friendship.  Then  she  volunteered 
to  say  that  liread  represented  a  friend  ;  that  a  big  piece  of 
bread  was  a  sign  of  a  large  friend  ;  that  butter  signified  refine- 
ment, and  bread  and  butter  a  refined  friend.  She  then  quickly 
said  that  cabbage  was  white  on  the  inside,  and  that  signified 
purity,  and  green  on  the  outside,  but  no  questioning  could 
make  her  say  what  the  green  meant.  She  continued  to  say  if 
one  cut  up  the  inside  of  cabbage  and  put  it  on  a  little  plate,  it 
would  indicate  purity  and  something  else  which  she  would  not 
disclose,  possibly  because  it  liad  reference  to  the  green  color. 
It  is  to  be  regretted  that  no  incpiiries  were  made  as  to  the  sig- 
nificance of  onions,  to  which  she  has  an  antipathy,  and  by  what 
articles  of  diet  she  represented  the  opposites  of  friendship, 
purity,  sweetness,  etc. 

"  Repeatedly  while  this  conversation  was  going  on  her  visitors 
were  warned  not  to  sjieak  loud,  as  persons  were  watching  all 
the  time,  up-stairs  and  down-stairs,  through  the  register,  pipes, 
etc.,  presumably  the  waste,  water,  or  gas  i)ipes,  none  of  which, 
however,  could  be  seen  on  casual  inspection.  These  persons 
were  also  said  to  whisper  to  her  through  these  tubes.     She  de- 


THE    LEGAL    RELATIONS    OF    IJN'SANriY.  149 

clared  that  this  food  language  was  not  peculiar  to  herself,  but 
was  known  to  and  in  constant  use  by  all  the  attendants  and 
patients ;  that  her  conversation  and  letters  were  communi- 
cated or  perhaps  telegraplied  about  the  house,  as  she  inferred, 
by  single  words,  said  by  different  persons,  in  various  places,  in 
the  midst  of  their  conversation,  and  by  putting  these  detached 
words  together,  she  found  out  by  something  in  her  heart  or 
chest,  not  in  her  head,  that  they  had  become  accjuainted  with 
the  letters  she  had  written,  and  the  conversations  she  has  had 
with  others,  and  presumably  with  herself. 

"  It  was  very  evident  that  Miss  Dickie  was  of  unsound  and 
imperfect  mind  and  understanding,  yet  for  an  hour  and  a  half 
she  had  given  no  positive  signs  of  absolute  mental  derange- 
ment. She  knew  who  and  where  she  was,  described  the  insti- 
tution as  a  honse  of  affliction,  but  she  made  no  allusion  or 
complaint  of  her  fellow-sufferers,  or  of  any  noises  or  annoy- 
ances except  the  imaginary  whisperings  through  the  tubes. 
She  was  conscious  of  her  own  weakness  and  ignorance  of  many 
things,  seemed  satisfied  to  have  as  her  guardian  a  bank  presi- 
dent, whom  she  named,  as  she  was  not  accustomed  to  deal  with 
large  sums  of  money.  In  short,  she  presented  the  usual  mix- 
ture of  reason  and  unreason  so  common  in  m-any  simple  luna- 
tics. Sometimes  she  exhibited  a  good  deal  of  I  act  and  cun- 
ning, at  other  times  of  extreme  childishness  and  simplicity, 
mixed  up  with  delusions,  hallucinations,  unfounded  suspicions, 
extreme  prejudices  and  hatreds,  great  Christian  piety,  charity, 
and  benevolence. 

*'  The  only  question  that  could  arise  was  whether  it  was  abso- 
lutely necessary  to  retain  her  in  the  asylum.  There  seemed  no 
objection  to  a  trial  elsewhere,  provided  all  her  property  should' 
not  pass  into  the  hands  of  strangers  and  irresponsible  persons; 
that  a  proper  residence  should  be  selected  where  her  peculiari- 
ties should  not  become  the  sport  of  the  foolish  and  indiscreet ; 
and  that  a  competent  maid,  nurse,  assistant,  or  matron  could 
be  found  possessed  of  unmeasured  patience,  tact  and  resolution.  ' 

In  such  cases,  it  undoubtedly  happens  that  the  patients  may 
fall  sometimes  into  the  hands  of  designing  guardians,  so  that 
the  legal  action  may  prove  rather  a  curse  than  a  blessing. 

A  case  where  interdiction  was  I  think  very  improperly  refused 
is  the  following  : 


Case  XLIII. 

(31  Louisiana  Annual  R.  757. 
Scott  Watson.  Sr.,  died  in  i8i^q,  leaving  a  widow  and  minor 


150  MEDICAL    JURISPRUDENCE. 

children,  and  the  widow  was  confirmed  as  natural  testatrix  of 
her  children.  In  1866  the  children  were  sent  to  France  to  com- 
plete their  education.  One  of  the  children,  Scott  Jr.,  who  was 
then  19  years  old,  and  was  described  as  ''the  brightest  boy  in 
school,  both  mentally  and  physically  sound,"  was  brought  home 
two  years  afterwards  in  a  condition  of  mental  idiocy  and  imbe- 
cility and  has  since  so  remained. 

It  1878  the  parish  judge  of  Tensas  made  a  decree  of  inter- 
diction. In  these  proceedings  it  was  shown  by  the  testimony 
of  two  physicians,  who  had  examined  him  the  previous  day,, 
that  he  vvas  very  weak  in  mind  and  body  and  was  unable  to 
take  care  of  his  property.  That  he  was  suffering  from  dementia. 
On  behalf  of  the  mother  it  was  shown  that  he  was  very  trac- 
table. That  the  only  violent  propensity  he  exhibited  was 
cutting  his  clothes.  That  he  ate  with  the  family  and  had  per- 
fect freedom  of  action  ;  and  that  he  manifests  a  very  warm  love 
for  his  mother. 

On  appeal  to  the  Supreme  Court  it  was  held  that  the  evi- 
dence adduced  was  not  sufficient  to  warrant  the  interdiction. 


Case  XLIV. — Application  for  Discharge    from  Asylum 
—NOT  Granted. 

Commonwealth  ex  rel  Dr.  Helmbold   ) 

7)s.  [-11  Philadelphia  R.  427. 

Kirkbride,  ) 

Dr.  Helmbold  who  had  been  regularly  committed  to  the 
Penna.  Insane  Asylum,  made  an  application  to  be  released 
therefrom,  denying  that  he  was  of  unsound  mind.  There  was, 
however,  as  the  Court  stated,  a  preponderance  of  evidence  to 
prove  his  insanity,  and  it  was  also  shown  that  he  had  during 
five  years  been  committed  to  insane  asylums  four  times  ;  also 
that  his  insanity  was  hereditary  and  that  two  brothers  and  an 
only  sister  were  then  confined  in  insane  asylums.  None  of  the 
testimony  is  given  in  the  opinion. 

On  the  grounds  above  stated  the  Court  refused  the  applica- 
tion. 

The  testimony  of  insane  persons  is  usually  not  received  in 
Court,  and  a  recent  decision  is  that  of 

Case  XLV, 

Hand     ) 
vs.        y    3  N.  Y.  Monthly  Law  Bulletin,  6, 
Burrows,   j 


THE    LEGAL    RELATIONS    OF    INSANITY.  151 

Application  for  a  commission  to  take  testimony  of  a  witness 
confined  in  an  insane  asylum  : 

Held,  that  if  the  witness  is  sane  he  can  be  produced  ;  if 
insane,    his  testimony  cannot  be  received  in  a  court  of  justice. 

By  some  judges  the  insane  person  is  permitted  to  testify  in 
his  own  behalf,  his  evidence  going  for  what  it  is  worth  with  the 
jury. 

Concealed  Insanity. — In  some  cases  lunatics  will  conceal 
their  insanity  when  upon  the  witness  stand,  so  that  their 
incarceration  may  be  looked  upon  as  an  outrage,  and  their  re- 
lease may  be  promptly  induced.  If,  however,  a  person  familiar 
with  their  delusions  properly  interrogates  them,  the  barriers  of 
self-restraint  are  broken  down  and  the  justice  of  and  necessity 
for  their  detention  becomes  evident.  A  stout,  healthy  looking 
Irishman  was  brought  into  one  of  the  Courts  upon  writ  of  habeas 
corpits  several  years  ago.  He  answered  the  questions  pro- 
pounded to  him  in  a  manner  at  once  ready  and  intelligent,  and 
the  lawyer  proceeded  to  shake  his  head  knowingly  and  comment 
upon  the  "burning  wrongs."  The  Superintendent,  who  had 
waited  patiently,  begged  permission  to  ask  the  prisoner  one 
question,  and  it  was  reluctantly  given.  It  was  simply  "  who  did 
you  say  you  were  ?"  Without  a  moment's  hesitation  the  wit- 
ness growing  flushed  and  excited  shouted  out  "  I  am  the  Lord 
Jesus  Christ,"  and  launched  forth  into  a  furious  exhortation. 
This  man,  it  is  needless  to  say,  was  promptly  sent  back  to  the 
asylum.  He  was  a  violent  and  dangerous  lunatic,  believing 
that  his  change  in  identity  gave  him  power  to  inflict  such 
punishment  as  he  saw  fit. 

The  Popular  versus  the  Scientific  Yiew  of  Insanity. 

— In  many  instances  it  is  difficult  to  make  an  ordinary  jury  ac- 
knowledge the  existence  of  lunacy,  for  the  average  layman  has 
his  own  idea  of  what  a  madman  should  do,  and  all  the  finer  dis- 
tinctions go  for  naught.  Until  the  time  arrives  when  it  will  not 
be  considered  necessary  for  an  insane  person  to  tear  his  hair 
or  drivel,  or  indulge  in  the  violence  which  is  found  only  in 
novels  and  on  the  stage,  we  may  expect  to  find  juries  more 
often  wrong  than  otherwise. 

A  case  where  the  jury  were  completely  deceived  by  the  pa- 
tient came  under  my  observation  a  few  months  ago  and  the  ludi- 
crous termination  of  the  affair  is  worth  recording.  A  certain 
man  of  respectable  family  and  in  comfortable  circumstances 
entertained  an  idea  that  he  was  an  apostle,  and  hired  a  hall  in 
the  Bowery  to  which  he  invited  the  young  women    and   mea 


152  MEDICAL    JURISPRUDENCE, 

from  the  streets,  and  the  result  was  that  the  place  was  crowdtd 
night  after  night  with  a  turbulent  crowd  of  young  thieves  and 
prostitutes.  Robberies  of  articles  upon  clothes  lines  in  cne 
neighborhood  were  committed  and  the  police  were  called  in. 
In  consequence  the  proprietor  was  arrested  and  brought  into 
court  and  committed  to  an  Asylum,  as  it  was  believed  his  con- 
duct was  that  of  an  insane  man.  His  religious  views  were 
novel  in  the  extreme,  but  the  jury  before  whom  he  subsequent- 
ly came  in  lunacy  proceedings  for  habeas  corpus  were  not  dis- 
posed to  consider  him  necessarily  insane  and  he  was  discharged 
from  the  custody  of  the  Asylum.  He,  however,  of  his  own 
volition  went  back  to  the  Asylum  where  he  staid  despite  the 
efforts  of  the  Superintendent  to  get  rid  of  him,  and  his  beha- 
vior Avas  clearly  that  of  a  lunatic.  He  threatened  to  sue  the 
physicians  who  committed  him  unless  they  gave  him  the  oppor- 
tunity to  deliver  his  peculiar  address  before  one  or  more  medical 
bodies.  I  examined  him  and  found  the  well  marked  symptoms 
of  early  general  paresis.  He  had  delusions  of  power,  and  had 
a  confidence  in  his  own  capability  as  a  reformer  that  was  re- 
freshing. His  theory  in  regard  to  the  Ijiimaculate  Conception 
was  that  it  was  through  a  kiss,  and  he  proposed  to  do  away  wiih 
the  ordinary  method  of  intercourse  and  substitute  apian  of  his 
own,  which  was  in  every  way  to  be  more  pure.  The 
patient  was  liberated  upon  application  of  a  lawyer  who 
was  one  of  the  strongest  agitators  in  the  movement  which  was  di- 
rected to  open  the  doors  of  lunatic  asylums,  and  his  interest  in 
his  client  was  very  great.  He,  however,  received  a  rude  check 
when  he  presented  his  bill  for  professional  services  and  the 
client  proceeded  to  issue  bonds  and  bank  notes  for  its  payment, 
which  he  made  Avith  a  pen  and  whatever  scraps  of  paper  he  could 
lay  his  hands  upon.     This  man   has  since  committed  suicide. 

Feigned  Insanity. — We  are  called  upon  very  often  to  de- 
cide the  cpieslion  whether  a  certain  alleged  lunatic  is  shamming 
or  not,  and  sometimes  the  task  is  one  of  great  difficulty.  The 
ability  to  detect  a  simulator  depends  much  upon  the  experi- 
ence, the  shrewdness  and  the  ])atience  of  the  medical  man.  He 
should  not  only  examine  the  person's  l)ehavior  presented  during 
the  interviews,  but  cause  him  to  be  closely  watched  ;  and  his  ac- 
tions for  some  time  j^revious  to  the  examination  should  be  investi- 
gated. The  medical  man  is  also  to  make  careful  physical  ex- 
aminations, the  pulse  and  urine  often  furnishing  striking  indi- 
cations. The  greatest  difficulty  of  the  simulator  of  insanity,  and 
in  fact  of  all  feigned   diseases  is  the  ina])ility  of   the   i)atient  to 


THE    LEGAL    RELATIONS    OF    INSANITY.  153 

keep  up  his  deception,  especially  wlien  he  believes  he  is  not 
watched.  Sometimes  he  will  overdo  the  part  he  strives  to  play, 
or  at  others  will  act  upon  a  hint  ])urposely  conveyed  without 
his  knowledge.  Such  a  case  is  that  reported  by  Montigna. 
Several  physicians  examined  the  individual  and  purposely  in  his 
hearing,  expressed  their  doubt?  of  his  insanity  for  several  rea- 
sons, one  being  that  he  retained  the  nourishment  they  gave  him, 
the  second  because  he  had  not  smiled,  the  third  because  he  had 
not  fixed  his  attention  upon  any  object.  The  ruse  succeeded 
and  he  changed  his  methods  in  a  way  to  remove  all  doubts  of 
the  physicians^  following  their  suggestions  as  closely  as  he 
could, 

Snell  says  »  *'  Common  people  have  not  the  slightest  rational 
idea  of  insanity.  They  believe  that  all  mental  manifestations 
are  completely  altered  in  it,  and  that  an  insane  person  knows 
nothing ;  that  he  ceases  to  read,  to  write,  and  to  reckon 
and  that  all  his  relations  and  conditions  are  completely  revers- 
ed, hence  it  happens  that  all  uninformed,  people  find  it  difficult 
to  acknowledge  actual  insanity.  When  they  speak  of  an  insane 
person,  thay  say  that  he  is  not  mad,  that  he  knows  every  one 
about  him,  and  that  he  altogether  conducts  himself  like  a  rea- 
sonable man,  only  that  he  shows  some  peculiarities.  Unedu- 
cated people  have  the  idea  that  an  evil  spirit,  as  it  were,  takes 
possession  of  an  insane  man,  and  drives  out  his  being  into  alto- 
gether new  and  perverted  elements.  When  they  observe  mem- 
ory, reflection,  feeling  of  right  and  wrong,  they  think  that  in- 
sanity cannot  exist  and  yet  among  the  insane  all  these  things 
are  seldom  altogether  wanting  and  often  exist  to  a  high  degree. 
On  this  rock  simulators  genevally  make  shipwreck  if  they  at- 
tempt a  part  at  all  active.  But  it  is  more  difficult  to  form  a 
judgment  if  the  simulator  preserve  a  complete  passiveness  and  an 
obstinate  silence.  It  is  not  impossible  that  by  these  means  in- 
sanity may  be  simulated  with  success,  yet  in  order  to  do  so 
the  simulator  must  possess  a  rare  strength  of  will  in  order, 
through  all  observation  and  tests,  to  preserve  his  role." 

There  are  certain  well  defined  features  of  real  insanity  the 
simulator  cannot  counterfeit,  however  skillful  and  cunning  he 
may  be.  He  cannot  remain  watchful  any  great  length  of  time, 
he  must  eat  and  he  can  never  voluntarily  present  the  pulse  and 
temperature  changes  of  melancholia  or  mania.     *  Gavin  says 

*  Zeitschrift  fur  Fsychiatrie,  Dec.  1855,  quoted  by  Bucknill  and  Tuke,  p. 

470. 

*P  I70. 


154  MEDICAL    JURISPRUDENCE. 

on  feigned  diseases  :  "On  points  directly  involving  liis  inter- 
est, the  impostor  will  display  the  full  endowment  of  the  shrewd- 
ness compatible  with  this  condition,  while  his  stupidity  is  re- 
served for  occasions  where  his  interests  are  not  particularly  con- 
cerned, his  replies  notwithstanding  his  imbecility,  never  tend 
to  criminate  himself  ;  but  whatever  he  says,  is  rather  meant  to 
induce  a  belief  in  his  innocence  ;  and  this  game  he  pushes  as 
far  as  he  dares." 

Ray  states  "  that  where  the  person  replies  to  inquiries  in  such 
a  manner  as  to  criminate  himself,  it  may  be  pretty  safely 
concluded  that  the  imbecility  is  genuine  ;  and  though  the  con- 
verse of  this  rule  may  just  be  equally  true,  yet  if  the  whole  tenor 
of  his  replies  be  of  an  exculpatory  turn,  strong  ground  of  suspi- 
cion, at  least,  is  afforded,  that  all  is  not  right." 

The  nature  of  the  act  itself,  which  is  alleged  to  be  of 
an  insane  nature,  should  be  taken  into  account,  with 
the  possible  existence  of  motives,  the  possibility  of  a  de- 
sire for  revenge  or  gain,  the  existence  of  an  unfortunate  and 
unprofitable  business  contract,  or  the  desire  to  escape  some  dis- 
agreeable duty  are  suspicious  circumstances  and  may  suggest 
the  groundwork  for  perjury.  I'he  possible  existence  of  pre- 
vious symptoms,  if  any,  will  throw  some  light  upon  the  present 
condition  of  the  person,  and  the  various  questions  of  heredity, 
the  history  of  head  injury  and  the  presentation  of  symptoms  al- 
luded to  upon  a  previous  page  are  to  be  weighed,  although,  so 
far  as  heredity  is  concerned,  it  will  be  found  that  man)'^  vicious 
criminals  have  a  well  marked  nervous  saturation  from  trans- 
mitted taint  from  insane  ancestry.  Macdonald  and  others  al- 
lude to  the  fact  that  there  is  an  absence  of  the  change  of  char- 
acter so  universal  in  insanity  ;  so,  too,  he  points  out  that  the 
alleged  insane  act  is  suspicious  if  it  is  the  first  evidence  of  the 
insanity — "  an  act  of  violence  is  never  the  first  symptom  of  in- 
sanity." The  simulator  of  insanity  will  indirectly  repudiate  all 
knowledge  of  persons  with  whom  he  was,  perhaps,  formerly  inti- 
mate, though  he  may  know  the  names  of  officers  of  the  jail  where 
he  may  be  confined.  He  shows  an  eagerness  to  avoid  the  recogni- 
tion of  persons  which  is  too  marked  to  be  natural  and  usually 
springs  from  an  obstinacy  which  he  adopts,  believing  it  necessary 
to  keep  up  this  form  of  ignorance.  Ray  calls  attention  to  the 
fact  that  the  impostor's  interest  in  his  family  does  not  lessen. 

A  forgetfulness  of  names  and  dates  is  very  suspicious,  espec- 
ially if  in  the  course  of  a  long  conversation  the  malingerer  has 
given  them  correctly  upon  a  previous  occasion,  or  if  he  jileads 
Joss  of  memory  as  a  result  of  disease. 


THE    LEGAL    KLLATIOKS    OF    INSANITY.  155 

The  simulator  will  often  disclaim  any  knowledge  of  what  he 
has  done  or  what  he  is  doing.  He  will,  j)erhaps,  say  that  he 
has  delusions,  and  that  he  acted  under  their  dominance. 
The  absurdity  of  this  becomes  at  once  apparent,  for,  as  Casper 
says,  "  the  instant  they  acquire  the  knowledge  that  their  delu- 
sion is  a  delusion  it  ceases  to  exist  as  such."  In  fact,  the  real 
lunatic  will  not  admit  that  he  is  insane. 

Feigned  Mania. — Mania  is  often  shammed,  and  usually  by 
persons  of  mediocre  intellect,  the  consequence  being  that  the 
popular  idea  of  madness  is  carried  out,  and  detection  is  the  in- 
variable result.  We  find  that  such  persons  overact.  No  pre- 
tended delusions  are  too  extravagant,  and  the  malingerer's  con- 
duct is  entirely  too  violent  to  last.  The  real  victim  of  true 
mania  presents  physical  symptoms  which  are  beyond  the  simu- 
lator. The  quick  pulse,  the  furred  tongue,  and  the  dry  skin 
are  indications  that  are  in  themselves  almost  conclusive.  The 
person  who  thrashes  about  to  carry  out  his  idea  of  mania  sweats 
profusely.  This,  coupled  with  profound  sleep  after  great  ex- 
ertion, Bucknill  considers  to  be  more  than  suspicious.  Under 
certain  circumstances  various  tests  have  been  applied  such  as 
the  administrations  of  anesthetics  and  corporeal  punishment, 
but  these  are  not  always  to  be  recommended. 

As  a  rule,  the  patient  who  is  feigning  mania  is  very  apt  to  try 
his  hand  in  other  directions  and  may  manifest  the  symptoms 
of  melancholia  ;  after  all,  inconsistency  is  the  feature  of  the  de- 
ception. 

Gavin,  *  whose  article  upon  feigned  insanity  is  the  best  of 
which  I  know,  says  : 

"  The  real  monomaniac  never  troubles  himself  to  make  the 
subject  of  his  delusion  accord  with  other  notions  having  rela- 
tion to  it;  and  the  spectator  wonders  that  he  fails  to  observe  the 
inconsistency  of  his  ideas,  and  that  when  pointed  out  to  him 
he  should  seem  indifferent  to  or  unaware  of  this  fact.  In  the 
simulator,  the  physician  will  discover  an  unceasing  endeavor  to 
soften  down  the  palpable  absurdity  of  his  delusions  or  reconcile 
them  with  correct  and  rational  notions.  This  marked  anxiety 
to  produce  an  impression  is  widely  different  from  the  reserve 
and  indifference  of  the  real  disorder,  and  will  of  itself  furnish 
almost  conclusive  proof  of  simulation." 

The  peculiar  bodily  odor  so  marked  in  mania  is  absent  of 
course  when  the  disease  is  simulated.     The  clothing  and  bed- 

*  Ray's  Medical  Jurisprudence  of  In-sani^y,  pp.  318,  319. 


156,  MEDICAL    JURISPRUDENCE. 

covering  always  become  impregnated  with  this,  and  it  is,  of 
course,  most  distinct  in  the  morning  after  the  room  has  been 
shut  up.  Esquirol,  Barrows,  Knight  and  Hill  all  place  great 
reliance  upon  this  test.  The  greasy  appearance  of  the  skin,  so 
marked  in  some  patients,  or  the  scurfy  dryness  are  disease 
manifestations  which  are  absent  in  he  who  shams. 

The  simulator  rarely  feigns  Idiocy,  and  if  he  attempts  to  do 
so  he  cannot  succeed.  The  physical  deformities  are  beyond  his 
reach — the  shape  of  the  head,  the  teeth,  the  ocular  symptoms. 
If  we  have  any  doubt  it  is  only  necessary  to  inquire  into  his 
previous  history. 

lMll)ecility  is  a  condition  that  is  still  likely  to  be  simulated. 
Le  Grand  du  Saulle  calls  attention  to  the  fact,  however,  that  the 
imbecile  may  for  a  purpose — to  escape  punishment,  for 
instance, — sham  and  feign  more  grave  conditions.  The  case  of 
Guiteau  furnishes  us  witli  an  example  of  this  kind.  Of  weak, 
vicious  mental  organization,  he,  when  threatened  with  punish- 
ment, clumsily  resorted  to  methods  of  simulation  which  he  be- 
lieved would  at  least  convince  one  or  more  of  the  jury  of  his 
insanity.  His  so-called  delusions  were  innumerable  and  always 
expressed  dramatically  in  court.     He  was  "  God's  man." 

In  jail  he  was  a  very  different  person  and  never  manifested 
any  such  nonsense  ;  his  pulse  was  regular,  his  bodily  functions 
good.  He  never  attempted  to  deceive  those  who  visited  him 
who  he  knew  were  able  to  see  through  his  tricks.  (See  pre- 
vious page). 

Feigned  Melaiicliolia. — Melancholia  is  seldom  shammed, al- 
thougli  certain  forms,  notably  those  characterized  by  a  fixed  delu- 
sion, might  be  feigned  with  comparative  ease.  Gavin  says  of  this  : 
"  The  true  melancholic  seeks  to  shut  up  Avithin  himself  his  sad 
ideas,  or  at  least  he  speaks  but  little  of  them,  and  betrays  him- 
self less  by  his  discourse  than  by  his  physiognomy,  his  coun- 
tenance, gestures  and  whole  external  habit.  'Jhe  signs  indica- 
tive of  it  are  the  more  apparent  the  less  he  believes  himself 
observed.  The  contrary  takes  place  in  simulated  melancholia, 
unless  one  has  got  to  deal  with  an  experienced  impostor.  The 
simulator  is  deficient  in  the  presiding  principle,  the  ruling  de- 
lusion, the  unfounded  aversions  and  causeless  attachments 
which  characterize  insanity.  He  is  unable  to  mimic  the  solemn 
dignity  of  characteristic,  madness,  nor  recurs  to  those  associa- 
tions which  mark  this  disease  ;  and  he  wants  the  peculiarity  of 
look  which  so  strongly  impresses  an  experienced  observer." 


THE    LEGAL    RELATIONS   OF    INSANITY.  I57 

Feigned  Dementia. — Dementia  is  more  often  feigned  than 
melancholia,  but  not  so  frequently  as  more  dramatic  and  noisy 
troubles.  The  simulator  will  be  apt  to  be  ignorant  of  the  fact 
that  memory  in  regard  to  recent  events  is  affected  in  the  dis- 
ease, and  that  the  remembrance  of  remote  events  is  fairly  good. 
He  cannot  possibly  consistently  carry  out  the  deception  when 
he  attempts  to  feign  the  incoherent  loquacious  stage  of  the 
disease. 

It  seems  hardly  possible  that  any  one  would  attempt  to  sham 
the  mental  symptoms  characteristic  of  organic  disease  of  the 
brain,  but  such  a  case  occurred.  In  several  of  the  English 
works  upon  medical  jurisprudence  the  case  of  Jaikes  is  pub- 
lished, who  while  under  trial  for  picking  pockets  fell  in 
a  pretended  apoplectic  fit,  and  when  he  returned  to  con- 
sciousness feigned  hemiplegia  and  secondary  dementia  so  suc- 
cessfully as  to  deceive  several  medical  men,  who  recommended 
his  commitment  to  an  asylum,  from  which  he  subsequently 
escaped.     This,  however,  is  an  exceptional  instance. 

Ray  alludes  to  the  fact  that  no  matter  how  skillfully  demen- 
tia may  be  counterfeited  there  is  always  a  kind  of  hesitation 
upon  the  part  of  the  person  who  feigns,  which  suggests  delibera- 
tion of  what  he  will  do  next.  He  halts  so  that  his  exaggerated 
ideas  do  not  succeed  each  other  as  they  would  in  true  dementia 
nor  so  rapidly.  Forgetting  the  fact  that  the  excitement  of  de- 
mentia is  continuous,  he  falls  into  the  error  of  assuming  a  kind 
of  periodicity. 

Criminal  cases  are  numerous  when  insanity  is  feigned- 
To  a  man  who  has  no  defense  the  assumption  of  the 
insane  state  is  a  natural  way  out  of  his  difficulties,  and  it 
cannot  be  denied  that  many  of  the  persons  that  are  sent  to 
asylums  by  judges  and  juries  are  mere  impostors. 


Case  XLVII. 

The  Barr  Case.— Dr.  Walter  Channing  reports  the  follow- 
ing case  of  feigned  insanity  which  created  a  great  deal  of 
interest  at  the  time  of  trial :  ^' 

"  It  is  doubtful  whether  William  Barr,  the  subject  of  thib 
sketch,  feigned  in  the  first  place  in  order  to  be  transferred  to 
the  asylum.  In  all  prisons  there  is  a  class  of  incorrigibles  who 
constantly  chafe  against  discipline,  and  Barr  was  one  of  the 
worst  of  this  kind.     Becoming  unmanageable   in  the  prison  he 

*  Boston  Medical  and  Surgical  Journal,  May  23,  187S. 


158  MEDICAL    JURIS!  KUDliNCt* 

was  sent  to  the  asylum  for  the  relief  of  the  officials.  The  first 
we  hear  of  him  is  at  Clinton  State  Prison,  at  Dannemora,  N. 
Y.,  to  which  he  was  sentenced  in  1871  for  ten  years  for  high- 
way robbery,  and  from  which,  after  remaniing  nearly  a  year,  he 
was  transferred  to  the  State  Asylum  for  Insane  Criminals  at 
Auburn.  Here  he  remained  nearly  two  years,  the  last  seven 
months  of  this  period  being  under  my  observation.  From  the 
asylum  he  was  sent  to  the  Auburn  State  Prison,  staying  nearly 
six  months,  when  he  again  entered  the  asylum,  remaining  nine 
days.  He  then  returned  to  the  prison  again,  where  he  staid 
until  some  time  after  the  homicide,  which  he  there  committed. 
During  this  period  he  has  a  history  for  violence  and  intracta- 
bility, but  all  the  very  conflicting  evidence  given  upon  the  trial 
furnishes  no  clear  proof  of  insanity. 

"  In  February,  1877,  Barr  murdered  a  prison  keeper  named 
Casler,  who,  it  is  stated,  had  borne  an  unusually  good  reputa- 
as  a  keeper,  and  beyond  reporting  convicts  for  bad  behavior 
had  never  had  any  trouble  with  them.  The  circumstances  of 
the  murder  were  substantially  as  follows  : — 

"  Barr  was  one  of  a  gang  of  convicts  shoveling  snow  off  the 
sidewalk  in  front  of  the  prison.  The  gang  was  in  charge  of 
Casler.  Whenever  a  woman  went  by  Barr  would  stop  and 
smile  at  her  ;  he  would  also  neglect  his  work  and  walk  up  and 
down  the  sidewalk.  He  began  after  a  while  to  throw  snow  in 
the  gutter,  which  the  keeper  told  him  not  to  do  ;  he  talked  to 
another  convict,  which  the  keeper  also  told  him  not  do  ;  finally, 
the  keeper  told  Barr  that  if  he  did  not  stop  he  should  send  him 
in,  but  Barr  said  he  would  go  when  the  rest  did.  The  keeper 
wrote  a  note,  which  Barr  probably  supposed  concerned  him, 
and  sent  it  by  another  convict,  and  then  turned  his  back  to 
Barr,  and  began  talking  to  some  passer-by.  Barr  ran  up  and 
struck  him  with  the  edge  of  his  iron  shovel  on  the  side  of  the 
face.  The  blow  knocked  the  keeper  over.  Barr  followed  it  up 
with  three  or  four  other  blows  and  kicks,  until  another  convict 
told  him  that  he  would  kill  him  (Barr)  if  he  did  not  stop.  'I  his 
threat  made  him  desist,  and  he  was  taken  into  the  prison.  The 
keeper  expired  in  a  few  moments. 

"  The  murder  created  the  most  intense  excitement  in  the  town, 
not  only  because  of  the  brutal  manner  of  the  killing,  but  be- 
cause the  murderer  had  twice  been  an  inmate  of  the  Asylum 
for  Insane  Criminals.  The  latter  fact  was  noised  abroad  in  the 
papers.  The  feeling  became  generally  prevalent  that  Barr  was 
insane,  and  jjublic  juc\gment  was  biased  to  a  most  unreasoning 
extent  bv  oreiudice. 


The  legal  relations  of  insanitv.  159 

"  He  was  indicted  for  murder,  and  in  October  last  was  ar- 
raigned for  trial.  He  made  no  reply  when  asked  the  usual 
questions  and  his  counsel  interposed  the  plea  of  insanity  as  his 
sole  defense."  *  *  *  ^^  commission  in  lunacy  to  examine 
into  the  mental  condition  of  the  prisonor  was  appointed. 
After  an  extended  investigation  they  found  that  Barr  was  sane 
both  at  the  time  of  the  homicide  and  when  they  examined  him. 
It  would  appear  at  first  sight  that  the  finding  of  a  commission 
of  experts  might  so  definitely  settle  the  question  of  insanity 
that  it  could  no  longer  be  an  element  in  the  defense.  If  the 
prisoner  is  insane  he  may  be  remanded  at  once  by  order  of  the 
court  to  an  asylum.  By  so  doing  the  expense  of  a  trial  is 
avoided.  When,  however,  a  commission  finds  the  prisoner  sane 
the  defense  of  insanity  can  still  be  used,  and  the  finding  of  a 
commission,  beyond  a  certain  moral  weight  it  bears,  is  of  no 
service. 

"Barr's  counsel  accordingly  used  insanity  as  his  sole  defense. 
Portions  of  the  evidence  taken  before  the  commission  was  read 
simply  as  the  testimony  of  certain  persons.  The  trial  lasted  a 
week.  The  jury  stood  at  first  nine  for  a  verdict  of  guilty  and 
three  for  acquittal  on  the  ground  of  insanity  ;  a  verdict  of 
murder  in  the  second  degree  was,  however,  finally  brought  in, 
and  Barr  was  sentenced  to  prison  for  life.  He  received  his 
sentence  with  stolid  indifference.  On  being  told  that  he  had 
got  off  very  lightly  he  said  he  did  not  care.  At  the  prison, 
when  received  there  from  court,  he  was  asked  why  he  didn't 
recognize  some  of  his  old  keepers  ;  he  replied  that  he  wasn't 
•  recognizing  any  one  then. 

"  Reviewing  the  evidence  given  in  this  case,  it  will  first  be 
found  that  the  reasons  of  the  physician  at  the  state  prison  at 
Dannemora  for  transferring  Barr  to  the  asylum  were  contra- 
dictory. He  makes  a  diagnosis  of  one  form  of  insanity,  acute 
mania  of  several  moiiths'  duration,  and  then  says  he  was  mel- 
ancholic. He  shows  that  Barr  was  insubordinate,  violent  and 
noisy,  but  considering  his  low,  brutal  nature  these  acts  are  not 
necessarily  indicative  of  insanity.  *  *  *  jje  was  afflicted 
with  a  cerebral  hyperesthesia,  and  was  in  a  state  of  constant 
nervous  erethism,  ready  to  explode  at  any  moment. 

"The  first  year  and  a  half  of  Barr's  residence  at  the  asylum  is 
a  blank  ;  we  know  only  that  he  was  still  vicious  and  insubordi- 
nate. During  the  seven  months  of  my  observation  of  him 
there  I  always  found  a  cause,  however  trivial,  for  his  bad  be- 
havior. Generally  when  his  passion  subsided  he  would 
acknowledge  that  he  had  done  wrong,  and  promise  to  be  good, 


I60  MEDICAL   JURISPRUDENCE. 

and  actually  did  better  for  a  few  days.  Among  the  patients  he 
had  found  several  old  pals.  These  he  often  incited  to  mischief, 
and  endeavored  to  make  them  join  vi^ith  him  in  fights  and  at- 
tempts at  escape,  thereby  showing  a  power  or  desire  of  com- 
bining which  in  the  lunatic  would  almost  never  be  found.  The 
necessary  lack  of  severe  discipline  at  the  asylum,  the  associa- 
tion  with  the  weak  and  sick  insane,  and  all  the  surroundings, 
so  different  from  a  prison,  did  much  to  develop  the  ungovern- 
able elements  in  Barr's  character.  He  learned  his  vast  power 
of  evil  and  freely  exercised  it,  considering  himself  irresponsi- 
ble because  a  lunatic. 

"Leaving  the  asylum  and  going  to  the  prison  his  conduct 
does  not  improve  ;  he  is  called  a  '  luny,'  and  his  behavior  re- 
garded as  that  of  an  insane  man.  He  whistles  on  Sunday  in 
the  chapel,  but  is  not  punished,  as  the  warden  says  he  is  not 
'all  right.'  (But  only  a  short  time  before  this  a  convict  had 
done  the  same  thing,  and  said  that  the  devil  was  in  his  cell, 
and  had  been  sent  to  the  asylum.  There  he  confessed  that 
some  feigners  who  had  previously  been  in  the  asylum  told  him 
how  to  'play  crazy.'  Barr  knew  these  same  persons,  and 
without  doubt  also  knew  this  recipe  for  insanity.)  Finally, 
after  threats  to  kill  several  persons  (he  said  he  would  get  over 
to  the  asylum  again  if  he  had  to  kill  a  keeper)  and  various  acts 
of  insubordination,  the  prison  physician  certifies  that  he  is  the 
victim  of  melancholia  and  paroxysmal  mania  and  again  he 
enters  the  asylum.  There  no  vestige  of  either  can  be  discov- 
ered ;  he  is  bright,  perfectly  well,  and  tractable  until  some  trifle 
makes  him  angry.  He  thinks,  however,  himself,  that  he  is 
insane,  and  says  his  head  is  not  right  ;  but  the  insane  do  not 
think  themselves  insane. 

"Again  he  goes  to  prison,  behaves  somewhat  better,  and  for 
two  months  before  the  homicide  the  warden  hears  nothing  of 
his  insanity. 

"  The  circumstances  of  the  murder  were  horrible,  but  still 
more  terrible  and  unjustifiable  murders  have  been  committed 
by  sane  men.  The  keeper  had  made  Barr  angry,  and  it  was 
natural  that  a  man  with  his  temper  should  raise  whatever  he 
might  have  in  his  hand  and  strike  with  it.  More  might  be  said 
on  this  point,  but  it  seems  unnecessary.  Barr  gives  his  reason 
for  having  struck  the  keeper,  saying  that  he  would  not  be 
imposed  on,  and  the  keeper  was  imposing  on  him. 

"  After  the  homicide  he  no  donbt  has  the  old  feeling  that  he  is 
regarded  as  insane,  and  he  is  still  very  violent  and  troublesome 
when  irritated.     He  now  speaks  occasionally  of  devils.     At  the 


THE   LEGAL    RELATIONS   OF   INSANITY.  l6l 

county  jail  he  is  at  first  troublesome,  but  on  being  punished 
his  manifestations  of  violence  cease.  This  change  alone  is 
strong  evidence  of  sanity.  A  person  violent  enough  to  be 
yelling  and  whistling  sufficiently  loud  to  disturb  the  neighbor- 
hood would  be  affected  with  violent  mania,  and  punishing  such 
a  person  would  have  no  other  effect  than  aggravating  the 
symptoms.  As  the  time  of  the  trial  draws  near  he  becomes 
quiet,  and  knows  and  talks  with  almost  no  one.  If  he  does 
talk  it  is  to  speak  of  devils.  The  idea  of  seeing  spirits  and 
devils  is  one  that  generally  occurs  first  to  ignorant  people. 
Barr  seems  to  realize  that  his  knowledge  is  too  limited  to  allow 
him  to  feign  the  violent  forms  of  insanity,  and  he  therefore 
fixes  on  the  stupid,  quiet,  non-committal  form. 

"  '  The  feigner  generally  mixes  the  appearances  of  several 
forms  with  each  other,  so  that  an  unnatural  representation  of 
disease  is  offered.  He  usually  overdoes  the  phenomena  of 
mental  disturbance.  He  believes  that  all  must  be  reversed  ; 
instead  of  giving  expression  to  delirious  ideas  he  talks  absurdly, 
and  conducts  himself  as  if  in  insanity  the  greater  part  of  the 
intelligence  and  of  the  memory  must  be  disturbed.'  *  Barr  is 
interested  in  his  trial,  prepares  himself  daily  for  it,  and  is 
impatient  when  it  does  not  begin.  Here  is  showing  interest, 
attention,  and  muscular  activity  ;  but  he  gets  into  the  court- 
room and  is  too  demented  to  answer  the  simplest  questions,  or 
obey  even  the  direction  to  stand  up.  At  the  same  time  he  keeps 
his  body  in  perpetual  motion,  laughs  and  mutters  to  himself, 
disturbs  the  order  of  the  court,  and  creates  a  scene  by  a 
tremendous  struggle  with  his  keepers  ;  here  again  he  launches 
into  mania. 

"  The  following  extract  from  a  conversation  of  Barr  with  the 
commission  is  very  striking,  resembling  in  many  respects 
reported  conversation  with  other  feigners: — 

Q.  How  old  are  you  ?  A.  I  don't  know,  sir.  Q.  Were  you  born  in  this 
country  ?  A.  I  don't  know.  Q.  Wiiat  is  your  name  ?  A.  Barr.  Q. 
What  is  your  first  name?  A.  William.  Q.  Your  brother's  name  ?  A.  I 
ain't  got  no  brother.  Q.  What  was  your  mother's  name?  A.  I  don't  know 
sir.  Q,  You  say  you  don't  know  where  you  were  born  ?  A.  No,  sir.  Q.' 
Do  you  mean  to  s^y  that  ?  A.  No,  sir.  Q.  Where  were  you  brought  up  ? 
A.  Tlie  devil  is  all  the  time  talking  tome.  Q.  Do  you  know  Captain  A  (a 
keeper  at  the  prison)  ?  A.  No.  Q.  Do  you  know  Captain  B  ?  A.  I  don't 
know  any  of  them  at  all.  Q.  Do  you  know  Captain  C  ?  A.  No.  Q.  Do 
you  know  Captain  D.  A.  Where  ?  Q.  Do  you  know  Captain  E  ?  A.  No, 
sir.  Q.  Do  you  know  your  brother's  name  now  ?  A.  You  know  the  devil 
is  all  the  time  talking  to  me  about.     Could   hear   him   well    enough,  and    I 

Griesinger,  page  I20. 
It 


t62  MEDICAL    jURlSPRtTDENCfi. 

don't  want  to  hear.  That  is  the  matter.  Q.  You  say  the  devils  are  all  the 
time  talking  to  you?  A.  Yes,  sir  ;  you  know.  Q.  What  do  they  say?  A. 
They  won't  let  me  rest.  Q.  Tell  this  gentleman  what  ihey  say,  and  he  will 
write  it  down.  A.  I  don't  want  it  written  down.  Q.  Can  you  read  or  write  ? 
A.  No,  sir.  Q.  When  did  you  forget  to  read  and  write  ?  A.  You  will  all  write 
too.  On  another  occasion  he  was  again  asked  where  he  was  born,  and 
replied,  "I  guess  so  ;  what  do  you  want  to  talk  to  me  for  ?  "  The  question 
was  repeated,  and  he  said,  ''Wiiat  are  you  talking  to  me  for?  There  are 
seven  hundred  thousand  devils  flying  around  ail  the  time  ;  you  know  what 
they  say." 

"  Barr  says  that  he  cannot  read  or  write,  and  with  the  excep- 
tion of  two  questions  answers  all  wrong.  Some  of  his  answers 
are  responsive,  but  many  irrelevant  and  absurd.  He  knows  his 
own  name,  but  neither  his  father's  nor  his  mother's.  When 
asked  his  iDrother's  name  he  is  afraid,  no  doubt,  that  his  bro.ther 
may  be  found,  and  says  '  I  ain't  got  no  brother.'  When  asked 
if  he  knows  certain  persons  he  gives  incorrect  and  different  an- 
swers. His  replies  are  nearly  all  in  the  negative,  as  if  he  had 
resolved  to  respond  in  that  way.  He  also  tries  to  drag  in  devils 
in  his  irrelevant  answers,  but  he  shows  no  originality  in  so  do- 
ing, always  repeating  almost  precisely  the  same  words.  He 
merely  says  that  he  sees  or  hears  devils,  but  can  go  no  further, 
though  especially  interrogated  to  do  so.  In  true  mania  the 
lunatic  under  similar  circumstances  would  rattle  on  with  the 
most  perfect  volubility,  soon  changing  to  other  subjects  prob- 
ably, if  the  attack  were  acute  ;  if  chronic,  talking  rationally 
and  connectedly  of  his  delusions,  and  even  in  many  cases  an- 
swering other  questions  properly.  Barr's  apparent  delusions 
and  hallucinations  cannot,  therefore,  for  a  moment  be  dignified 
with  the  name  of  mania,  and  his  absurd,  almost  always  false, 
but  often  responsive  answers,  instead  of  showing  the  mental 
weakness,  as  loss  of  memory  and  attention,  etc.,  of  dementia, 
indicate  a  consistent  and  well-sustained  effort  willfully  and 
wrongly  to  answer  all  questions.  When  he  answers  two  ques- 
tions correctly,  giving  his  first  and  last  names,  he  is  evidently 
surprised  into  so  doing.  Barr  in  court  presents  the  picture,  to  a 
limited  extent,  of  advanced  dementia  and  violent  mania,  in- 
compatible, of  course,  in  themselves.  As  expert  testimony  is 
given,  showing  the  inconsistency  of  his  actions,  he  changes  ac- 
cording to  what  has  been  said.  He  has  never  looked  any  one 
in  the  eye,  but  on  hearing  that  real  lunatics  do  so  he  does  the 
next  day.  Though  too  stupid  to  recognize  any  one,  he  eyes 
persons  he  has  known  very  sharply,  doing  this  when  he  sup- 
poses himself  unobserved.  If  demented,  his  circulation  would 
be    sluggish,   his   hands  cold,    etc.  ;  if  maniacal,  more  active 


THE    LEGAL    RELATIONS   OF    INSANITY.  163 

Symptoms,  slightly  quiclcer  pulse,  Toss  of  flesh  and  sleep,  would 
be  present  ;  but  his  general  health  is  good,  his  weight  normal, 
and  he  sleeps  well.  The  latter  fact  is  of  special  importance  as 
still  further  excluding  mania. 

But  the  other  side  of  the  picture  is  seen  most  distinctly  when 
Barr  is  in  his  cell  at  night.  Here  the  most  plain,  positive,  and 
convincing  proofs  of  Barr's  feigning  are  brought  to  light.  The 
poor  lunatic,  too  demented  to  know  his  father's  name,  his  own 
age,  where  he  was  born,  etc.,  or  to  read  and  write,  or  to  under- 
stand what  is  said  to  him,  or  to  recognize  one  person  out  of 
many  he  has  known,  converses  with  the  convict  in  the  next  cell, 
an  old  friend,  after  the  other  prisoners  are  asleep.  Sometimes 
this  conversation  is  prolonged  until  he  tells  the  other  '  shut 
up;  I  must  go  to  sleep.'  Barr  borrows  papers  of  him,  which 
he  reads,  and  tobacco  and  cigars,  which  he  also  uses.  The 
other  convict  writes  him  a  note,  and  he  replies,  calling  him  by 
his  right  name  and  signing  his  own.  He  finds  out  that  the 
other  has  '  told  on  him,'  and  he  is  angry.  In  these  and  other 
ways  he  is  the  same  old  Barr,  interested  in  what  is  going  on, 
enjoying  the  luxuries  of  life,  at  times  irritable,  but  perfectly 
rational  and  true  to  his  own  nature," 


Case  XLVHI. 

The  Waltz  Case. — The  Waltz  murder  case  is  one  which 
gave  rise  to  much  controversy  some  years  ago.  The  facts  of 
the  homicide  and  the  subsequent  behavior  of  the  prisoner  are 
thus  detailed  by  Dr.  A.  E.  Macdonald.* 

"On  the  first  of  May,  1S73,  Joseph  Waltz  killed  an  itinerant 
knife-grinder  who  was  stopping  at  his  father's  house,  and  buried 
the  body,  and  part  of  the  effects  of  the  victim  upon  the  farm. 
The  method  with  which  the  crime  was  planned  and  perpetrated, 
and  the  care  taken  to  conceal  the  evidences  of  it,  all  showed 
coolness,  cunning  and  deliberation. 

"  Sixteen  days  elapsed  before  the  discovery  of  the  murder  and 
of  circumstantial  evidence  which  seemed  to  implicate  Waltz  and 
his  father  ;  and  during  those  sixteen  days  his  conduct  betrayed 
no  departure  from  his  usual  custom,  and  gave  no  evidence  of 
non-possession  of  his  faculties.  '  He  made  bargains,  trans- 
acted business,  and  kept  careful  accounts  of  his  payments  and 
receipts.'  When  the  unmistakable  evidence  of  his  guilt  was 
communicated  to  him,  and  he  found  also  that  his  father  was 

*    Am.   Psvcholonr.ill   'VorimriJ.     Mav     rS^ft 


l64  MEDICAL   JURISPRUDENCE. 

suspected  of  complicity  in  the  crime,  seeing  that  he  could  not 
save  himself,  and  desirous  of  saving  his  father  (who  had  appa- 
rently no  connection  with  or  knowledge  of  the  murder),  he 
made  a  complete  confession,  and  being  taken  to  the  farm, 
pointed  out  the  places  of  concealment  of  the  body  and  of  the 
property,  where  they  were  then  found.  In  this  confession  he 
described  minutely  the  details  of  his  crime,  relating  how  he 
went  to  the  woodshed  for  the  hatchet,  how  he  entered  the  room 
where  his  victim  was  lying  asleep,  turning  the  lamp  down  and 
placing  it  behind  the  head  of  the  bed,  so  that  the  light  might 
not  awaken  him  ;  how,  '  warned  by  the  inward  pleadings  of 
conscience,'  he  restrained  himself  and  withdrew  from  the 
room.  In  a  short  time  he  returned,  cautiously  as  before,  and 
struck  the  man  upon  the  head  a  single  blow  ;  then,  as  he  still 
breathed,  and  '  doubting  of  its  fatality/  he  struck  him  twice 
again.  He  goes  on  to  describe  how  he  carried  out  the  body, 
and  hid  it  in  the  barn,  but,  reflecting  that  it  would  probably  be 
discovered  there,  removed  it,  burying  it  near  a  fence  and  cover- 
ing it  with  stones  and  subsequently  iaking  it  up,  burying  it  in 
the  orchard,  and  plowing  the  lot  so  as  to  remove  every  trace. 
He  similarly  disposed  of  the  grinding  machine  and  other  arti- 
cles belonging  to  the  deceased.  In  this  confession  he  ascribes 
his  crime  to  the  influence  of  evil  spirits,  controlling  and  direct- 
ing  him,  and  relates  how  he  strove  to  resist  their  domination 
and  prayed  for  delivery  from  them. 

"Shortly  before  the  arrest  of  Waltz,  and  while  search  was 
being  made  for  him,  some  of  the  tool?  beiongmg  to  the  mur- 
dered man  were  found  upon  the  road  at  a  distance  from  the 
scene  of  the  murder,  and  upon  a  telegraph  pole  near  by  was 
pinned  a  letter,  which  turned  out  to  be  an  announcement  that 
the  murder  had  been  committed  by  a  band  of  traveling  high- 
waymen who  had  since  left  for  other  localities.  Upon  exami- 
nation, the  handwriting  of  this  document  proved  to  be  that  of 
Waltz,  though  somewhat  disguised.  In  the  confession  from 
which  I  liave  already  quoted,  he  admits  its  prei)aration,  and 
describes  a  midnight  journey  for  the  purpose  of  placing  it 
where  it  was  found.  He  also  confesses  to  the  robbery  of  several 
school-houses  at  intervals  i)rior  to  the  murder,  and  to  the  fact 
that  after  the  latter  he  concealed  the  proceeds  of  these  rob- 
beries, 'for  fear  they  should  make  suspicion.' 

'Being  committed  to  await  hh  trial  for  murder,  six  or  eight 
weeks  passed  without  any  noticeable  change  in  Waltz's  de- 
meanor ;  he  was  quiet  and  well  conducted,  and  no  suspicion  of 
his  insanity  was  excited.     At  the  end  of  that  period  a  length- 


THE    LEGAL    RELATIONS    OF    INSANITY.  165 

ened  consultation  with  his  counsel  was  held,  and  it  is  said  to 
have  been  concluded  by  one  of  them  remarking,  '  Well,  Joe,  I 
don't  see  what  we  are  going  to  do  for  you  unless  we  try  to  make 
you.  out  insane  '  If  this  remark  was  really  made,  the  hint  was 
not  lost  upon  '  Joe.'  At  any  rate,  he  forthwith  began  to  man^'- 
fest  symptoms  of  insanity,  real  or  pretended.  A  practical  and 
efficient  means  of  determining  the  true  character  of  these  mani- 
festations was  adopted,  a  paper  was  prepared  in  which  a  list  of 
*  Signs  of  Insanity,'  some  of  them  fictitious  and  some  extrava- 
gant, was  giveii;  and  conveyed  to  Waltz  by  a  person  whom  he 
supposed  to  be  friendly  to  him.     The  paper  read  as  follows  : 

"  ■  Signs  of  Insanity, — A  vacant  stare  at  some  part  of  the 
room  as  though  the  person  saw  something  ;  screaming  aloud 
occasionally  as  though  they  saw  something  like  an  enemy,  an 
angel,  a  demon,  or  something  terrible,  accompanied  by  appa- 
rent fright.  Skulking  in  a  corner  ;  furious  and  breaking  every- 
thing to  pieces  within  reach  ;  resisting  every  ettort  to  quiet 
them  ;  turning  away  the  face  as  though  not  wishing  to  be  seen  ; 
frothing  at  the  mouth  ;  tearing  the  clothes  ;  biting  at  their 
clothes  and  even  biting  their  own  fingers.  When  lying  down  a 
disposition  to  lie  on  the  left  side,  or  throwing  the  right  hand 
over  the  head.' 

'*  Shortly  after  its  receipt  he  faithfully  reproduced  the  indica- 
tions specified. 

"At  the  trial  of  the  case  the  facts  of  the  murder  and  the  part 
Waltz  assumed  in  it,  were  proven  beyond  cavil  ;  and  the  ver- 
dict turned  upon  the  question  of  insanity.  In  the  court-room 
Waltz  continued  to  present  the  supposititious  evidences  of  in- 
sanity which  he  had  learned  from  the  paper,  and  was  at  first 
violent  and  furious.  Later,  upon  its  being  whispered  to  him 
by  one  of  the  physicians  that  he  was  overdoing  the  thing,  and 
hurting  his  case,  he  moderated  his  conduct,  and  was  for  two  or 
three  days  quiet  and  peaceable.  Later  still  he  was  told  that  he 
had  gone  to  the  other  extreme  and  was  too  quiet,  and  there- 
upon he  became  once  more  excited.  Now  this  was  pretty  con- 
clusive proof  of  the  sham  nature  of  his  insanity,  but,  through  a 
legal  objection,  it  was  excluded,  as  it  could  not  be  actually 
proved  that  he  read  the  paper.  And  it  is  better  that  the  ques- 
tion should  have  been  settled  in  a  more  scientific  way,  and  one 
more  open  and  above  board.  Although  a  murderer  is  not  per- 
haps entitled  to  much  consideration,  still  entrapping  him  into 
exposure  by  a  subterfuge,  perpetrated  under  the  false  pretense 
of  friendship,  cannot  exactly  comport  with  our  notions  of  fair 
play.     The  paper  and  evidence  connected  with  or  resulting 


lS6  MEDICAL    JURISPRUDENCE. 

from  it  being  excluded,  the  question  as  to  his  mental  condition 
was  left  to  be  decided  by  medical  and  general  evidence.  Of 
the  four  physicians  summoned  by  the  prosecution,  three  were 
positive  in  their  opinion  that  the  insanity  was  feigned,  while  the 
fourth  gave  a  similar  though  less  positive  verdict.  Two  phys- 
icians appeared  for  tlie  defense,  and  swore  that  they  considered 
the  prisoner  insane,  but  their  evidence  was  less  positive,  and 
not  so  well  sustained,  as  that  for  the  prosecution.  The  trial 
occupied  over  a  fortnight,  and  that  fact  and  the  additional  one 
that  more  than  seventy  witnesses  were  examined,  would  indi- 
cate that  every  opportunity  of  adducing  proofs  of  insanity  was 
fairly  given.  *  *  *  After  fifteen  minutes'  deliberation  the  jury 
agreed  upon  a  unanimous  verdict  of  *  guilty.' 

"  A  doubt  as  to  the  prisoner's  responsibility  still  existing  in 
some  quarters,  such  representations  were  made  to  Governor 
Dix  as  led  him  to  appoint  a  commission  of  experts. 

"They  found  the  prisoner  a  young  man  of  twenty-four,  well 
developed,  and  enjoying — as  he  had  all  his  life  enjoyed — good 
physical  health.  The  statements  of  his  father  and  friends 
showed  that  he  had  been  steady  and  well  conducted,  fond  of 
reading,  and  very  capable  in  farming  and  business  affairs.  No 
singularities  of  conduct  had  ever  been  observed,  and  he  had 
never  been  suspected  of  insanity,  or  any  tendency  to  it.  When 
the  commissioners  visited  him,  they  found  his  cell  well  supplied 
with  papers,  and  containing  a  few  books,  including  an  English 
Dictionary.  Upon  the  wall  were  drawings  of  geometrical  sym- 
bols, and  other  figures,  and  passages  of  Scripture  and  scraps  of 
rhymes,  some  original  and  some  quoted.  On  accosting  him  he 
stared  at  his  visitors,  without  replying,  save  by  a  sort  of  guttural 
sound.  He  then  moved  about  from  his  bed  to  the  floor,  some- 
times kneeling,  and  sometimes  lying  down  with  his  face  to  the 
wall.  At  first  he  gave  no  answer  to  questions,  but  afterwards 
answered  them  in  a  confused  way.  For  instance,  he  asserted 
that  he  did  not  know  his  age  ;  didn't  know  his  mother's  name  ; 
didn't  know  what  church  his  father  went  to.  He  said  he  was 
married  to  the  Queen  of  the  Lunarians  who  had  come  to  his 
cell  one  night,  and  being  asked  what  he  meant  by  '  Lunarians,' 
he  replied  it  was  something  about  the  moon,  and,  taking  the 
Dictionary,  turned  to  the  word  '  Lunary.'  When  questioned 
about  his  trial,  lie  said  : 

"  '  J  was  tried  in  summer  j  7Vore  an  overcoat  ;  tried  in  an  im- 
mense cro7vd  ;  thou  sands  of  people  ;  not  in  the  court-house  ;  never 
knew  of  a  coicrl-house  ;  never  saw  one  ;  7vcnt  through  the  door 
with  supernatural  strength  ;  counsel i  counsel?     /had,  no  (oun- 


THE    LEGAL    RELATIONS    OF    INSANITY.  167 

sel ;  no  Judge  was  there,  but  a  man  was  on  the  throne^  who  talked 
too  tmtchj  He  then  said  to  one  of  the  commissioners,  *  You 
are  the  governor^  and  to  the  other,  '  You  are  a  Judge.'  He 
denied  ever  coming  to  Catskill,  or  doing  any  business.  Said 
his  mother  bouglit  his  clothes  for  him.  In  reply  to  a  question, 
he  said,  *  /  killed  a  man  once,  oh,  yes,  he  was  a  good  man,  lie 
never  swore,  never  got  drunk  ;  I  never  made  a  confession. ' 

"  Being  finally  told  that  there  was  no  necessity  in  his  feigning 
and  so  stupidly,  he  instantly  replied,  '  Feigning !  Feigning 
what?'  Being  further  told  that  his  assumption  of  entire  igno- 
rance of  the  simplest  things  and  complete  loss  of  memory,  were 
inconsistent  with  his  state  of  health,  intelligent  appearance,  and 
the  books  and  papers  he  had  about  him  ;  as  also  with  his  being 
engaged  in  writing  in  them  and  the  prompt  use  of  the  diction- 
ary, he  said,  ^ Are  you  strangers?  I  don't  know  whether  I 
ought  to  talk  to  you.'  He  then  confessed  to  his  feigning 
and  said  he  would  tell  all  about  it,  and  at  once  threw  off 
all  simulation  Questioned  as  to  the  homicide,  he  repeated 
the  substance  of  the  confession  from  which  we  have  already 
quoted,  and  was  very  anxious  to  be  taken  out  and  to  the  scene 
of  the  murder,  saying  that  he  could  explain  the  matter  and 
point  out  the  localities  so  much  better  if  he  were  on  the  spot. 
He  also  described  how  he  had  accounted  to  his  father  for  the 
absence  of  a  blanket  which,  being  stained  with  blood,  he  had 
buried  with  the  body,  by  saying  that  Holcher  (the  murdered 
man)  had  carried  it  away  with  him;  how,  upon  the  strength  of 
this  tale,  his  father  started  by  the  road  which  Holcher  was 
supposed  to  have  taken  in  order  to  procure  his  arrest;  and  how 
he  (Waltz)took  advantage  of  his  father's  absence  to  further  de- 
stroy the  traces  of  his  crime  by  burning  the  machine  and  re- 
burying  the  body  in  a  more  secure  place.  He  acknowledged 
that  he  knew  at  the  time  of  the  murder  that  he  was  doing 
wrong,  but  claimed  that  he  was  tempted  and  controlled  by 
spirits.  Finally  he  offered  to  bribe  the  commissioners,  saying, 
'  If  you  help  me  with  the  Governor,  I  will  give  you  all  I  have. 
I  have  between  four  and  five  hundred  dollars,  and  an  interest 
in  the  farm,  and  father  will  add  to  it.' 

"  The  conclusions  reached  by  the  commissioners  after  a  care- 
ful examination  of  the  prisoner  and  consideration  of  the  testi- 
mony presented  at  the  trial  were  summed  up  by  thera  in  the 
following  words  : 

"  '  From  the  foregoing  voluntary  and  repeated  confessions  of 
the  prisoner;  from  the  evidence  adduced  upon  the  trial;  from 
the  statements  of  his  father,  and  from  a  personal  examin  ition 


l68  MEDICAL    JURISPRUDENCE. 

of  him  under  the  light  of  past  and  present  habitual  demeanor, 
there  is  no  escape  from  the  conclusion  that  the  prisoner  at  the 
date  of  the  homicide  committed  by  him,  possessed  all  the  ele- 
ments of  legal  and  moral  responsibility,  for  he  fully  knew  and 
comprehended  the  true  nature  and  consequences  of  the  act  he 
was  about  to  commit.  He  knew  it  to  be  both  wrong  in  itself 
and  a  wrong  to  his  victim,  since  he  successfully  resisted  its 
commission  for  a  while,  by  prayer  and  deliberation  upon  its 
enormity,  thus  evincing,  by  this  power  to  choose  between  two 
courses  of  conduct,  that  he  was  a  free  moral  agent.  Therefore 
we  are  of  the  opinion  that  the  homicide  was  the  act  of  a  sane 
mind,  knowing  that  the  act  it  was  about  to  commit  was  a  crime; 
intending  so  to  commit  it,  and,  with  full  power  of  refraining 
from  or  executing  its  wicked  purpose,  deliberately  preferring 
to  do  the  latter.' 

"  These  conclusions,  following  and  emphasizing  those  to  the 
same  purport  reached  in  succession  by  the  physicians  who  ex- 
amined Waltz  before  his  trial,  by  the  judge  who  presided  there- 
at, and  by  the  jury  which  convicted,  very  properly  led  the 
Governor  to  decline  to  interfere,  and  Waltz  was  duly  executed 
upon  the  anniversary  of  his  crime.  Upon  the  day  before  his 
death,  he  added  another  link  to  the  chain  of  evidence  in  favor 
of  his  sanity  by  killing  his  keeper,  in  a  manner  showing  pre- 
meditation, caution,  judgment  and  motive-— the  desire  to 
escape.  The  assault  was  made  with  a  bar  of  iron,  torn  from 
the  floor  and  bent  at  the  end  to  give  it  greater  weight;  the  oc- 
casion was  sought  when  the  keeper  lay  asleep  on  a  lounge;  the 
pools  of  blood  upon  the  floor  were  concealed  by  newspaj^ers 
spread  over  them;  and  Waltz,  taking  possession  of  the  keeper's 
keys  and  revolver,  was  only  prevented  from  using  them  to 
effect  his  flight  by  the  timely  arrival  of  other  officers." 

Persons  feign  insanity  at  times  when  they  desire  to  avoid 
meeting  obligations  they  have  contracted.  Casper  presents 
two  or  three  of  these  cases  in  the  first  of  which  insanity  was 
feigned  to  escape  conviction  for  perjury.  "  The  wife  of  a 
merchant,  L.,  had  ordered  clothes  for  lierson  in  January,  1849, 
and  in  a  subsequent  action  for  non-payment  she  declared  on 
oath  that  she  had  no  remembrance  of  having  given  any  such 
order.  The  circumstances  occasioned  a  suspicion  of  perjury, 
but  in  the  course  of  the  investigation  Mrs.  S.  alleged  that  she 
labored  under  a  great  weakness  of  memory.  C!harged  with  the 
task  of  investigating  this  matter,  the  following  (piestion  was 
put  me  to  answer,  '  is  the  memory  of  the  accused  in  such  a 
state  that  it  is  with  probability  to  be  assumed  that  an  order 


THE    LEGAL    RELATIONS    OF    INSANITY.  169 

given  by  herself  during  the  year  1849  could  be  completely  for- 
gotten by  the  20th  of  November,  1^50,  the  day  on  which  she 
took  an  oath  to  that  effect  ? '  Mrs.  S.  very  soon  betrayed  her- 
self, inasmuch  as  in  the  course  of  an  apparently  indifferent 
conversation  with  me  about  matters  wholly  unconnected  with 
the  investigation,  she  gave  the  readiest  answers  to  questions 
such  as,  how  old  her  husband  was,  the  ages  of  her  children, the 
diseases  they  had  gone  through,  etc.  Then  I  recurred  to  '  the 
unfortunate  circumstances  of  this  investigation,  and  its  possible 
lamentable  results,'  and  Mrs.  S.  did  not  fail  to  fall  into  this 
strain  and  to  describe  most  feelingly  her  unfortunate  position, 
her  poverty,  and  the  embarrassment  in  which  she  was  placed  by 
the  giving  of  this  oath,  evidently  to  procure  a  favorable  opinion 
from  us.  Consequently  she  herself  involuntarily  let  drop  the 
pretext  of  a  weakness  of  memory,  and  brought  forward  evident- 
ly the  true  causa  facinorisj  she  forgot  herself,  and  ceased  to 
keep  up  her  character!  Of  course  the  foregoing  question  was 
negatived." 

Doubtful  cases  of  Feigned  Insanity. — Sometimes  we 

encounter  very  trying  cases,  real  insanity  being  mistaken  for 
feigning,  but  these  examples  are  very  rare.  Casper  refers  to 
the  case  of  "a  youth  of  eighteen,  who  had  commited  several 
robberies,  and  was  convicted  of  the  crime  of  rape,  under  circum- 
stances which  brought  his  sanity  into  question.  The  investi- 
gation lasted  for  eleven  years,  during  which  period  he  was 
removed  from  one  prison  or  asylum  to  another,  and  no  less 
than  twenty  official  medical  reports  were  made  on  the  state  of 
his  mind,  most  of  which  agreed  in  the  conclusion  that  his  in- 
sanity was  feigned.  The  question  was  finally  referred  to  the 
Royal  Scientific  Commission  for  Medical  Affairs,  who  reversed 
former  decisions,  founding  their  opinions  on  the  following  facts, 
viz.:  persistent  silence,  lasting  for  fifteen  months;  continued 
exposure  of  his  body,  without  covering,  to  the  cold,  although 
clothing  was  within  his  reach;  vigilance  kept  up  night  after 
night;  complete  rejection  of  food;  swallowing  of  dirty  water  in 
preference  to  clean,  or  of  hard  innutritions  substances  ;  fre- 
quent attempts  to  commit  suicide  by  venesection;  no  betrayal 
of  himself  on  recovering  from  drunkenness  or  after  inhalation  of 
chloroform;  duration  of  all  these  symptoms  for  so  long  a  period 
(although  the  subject  of  them,  if  sane,  must  have  known  that 
simulation  was  only  lengthening  the. time  of  his  imprisonment); 
and,  finally,  the  existence  of  unquestionable  delusions." 


CHAPTER  IIL 

HYSTEROID   STATES,    AND    FEIGNED   DISEASES. 

Medico-legal  Consideration  of  Hysteria.— ^j/m«  often 

plays  a  part  in  the  court-room  and  in  the  police  station,  and 
very  often  is  not  recognized.  Some  one  has  said  that 
it  is  the  first  cousin  of  insanity,  which  is  only  too  true, 
and  when  responsibility  is  considered,  we  are  furnished 
with  a  perplexing  psychological  problem.  In  cases  of  black- 
mail, pretended  assaults  upon  the  person,  alleged  burglary, 
and  a  variety  of  other  crimes,  it  will  often  be  found  that  what 
Lutaud  defines  as  "a  morbid  excitement  of  the  genital  organs 
and  a  derangement  of  the  senses  and  imagination,"  will  often 
explain  the  motive  of  the  person  who  brings  a  charge. 

Natnre  of  Hysteria. — The  true  sign  of  hysteria  is  the 
perversion  of  the  affective  faculties  and  ideation,  and  the  need  of 
voluntary  resistance.  Le  Grand  du  Saulle,  in  an  admirable 
paper,  says  ;  "  Dr.  Constans  has  not  hesitated  to  represent  the 
greater  part  of  the  hysterical  patients  at  Morzines  as  being 
absolutely  irresponsible  for  their  actions.  Now,  an  affection 
which  is  but  the  expression  of  a  peculiar  susceptibility  of  the 
nervous  system,  and  not  a  mental  disease,  can  very  rarely  over- 
power moral  liberty  and  exclude  all  culpability.  Hysteria 
shakes  the  cerebral  edifice,  exercises  a  powerful  influence,  if 
you  will,  over  the  emotional  faculties,  and  sometimes  ends  by 
inducting  a  true  lesion,  but  ordinarily  the  intellectual  faculties 
remain  intact."  * 

Most  authors  agree  that  the  cases  where  irresponsibility  is 
greatest  are  those  met  with  among  young  girls  in  whom  the 
melancholic  tendency  is  hereditary,  and  in  whom  actual  insanity 
supervenes.  In  such  cases  the  intellectual  development  is 
arrested,  and  usually  so  at  puberty  or  at  some  equally  important 
period. 

Hysteria  and  Lust. — Cases  are  on  record,  and  Tardieu 

*  On  Partial  Responsibihty,  etc.  Translation  in  Psychological  Journal, 
vol.  1 6,  p.  668. 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  I71 

furnishes  an  example  of  women  who  prostitute  themselves  with- 
out reference  to  the  social  condition  of  the  male  ;  and  he  fur- 
nishes the  case  of  a  young  Austrian  noblewoman  of  great  beauty 
who  offered  herself  to  every  man  she  met,  even  to  the  lowest 
street  character.  She  subsequently  decapitated  her  child,'  and 
did  not  appreciate  the  nature  of  her  criminal  act. 

I  have  lately  seen  a  young  lady  of  excellent  family  the  sub- 
ject of  hysterical  insanity  who  offered  her  person  to  male  ser- 
vants, railway  porters,  and  persons  far  below  her  socially,  and 
another  case  of  the  kind  dependent  upon  some  sexual  irritation 
caused  the  unhappy  victim,  the  morning  after  her  marriage,  to 
seek  the  caresses  of  her  coachman.  In  both  these  cases  there 
was  attendent  intellectual  perversion  of  other  kinds  which 
rendered  both  the  young  women  irresponsible  for  their  conduct. 

Hysteria  Manifested  in    Religious   Ta;^arie>i. — The 

recent  case  of  Lizzie  Gannon  is  a  curious  example  of  what  one 
would  rather  look  for  in  the  last  century  than  to-day.  Lizzie 
Gannon,  a  child  of  eight  or  ten  years,  became  hysterical  and 
presented  the  various  trance  states  which  were  exhibited  by 
Louis  Luteau  in  France  and  other  sfigmati'sed pa.t'ient?,.  A  feature 
of  her  condition  was  the  worship  of  certain  paper  dolls,  and  when 
the  ministrations  of  a  sensible  Catholic  priest  were  solicited,  he 
promptly  took  the  things  away  from  the  child.  The  testimony 
of  several  witnesses  was  printed  in  the  New  York  Times  of 
April  7,  1883. 

"The  trial  of  the  suit  against  Archbishop  Williams  and  a 
curate  for  alleged  injury  done  the  sick  child  Lizzie  Gannon  by 
depriving  her  of  paper  images  which  she  idolized  as  '  angels,' 
was  continued  to-day  in  the  Superior  Court.  Further  evidence 
was  introduced  by  the  prosecution  to  show  that  the  girl's 
acutest  sufferings  were  immediately  subsequent  to  the  loss  of 
these  images.  The  mother  of  the  girl  was  further  examined, 
also  a  couple  of  schoolgirls,  a  sister  of  the  mother,  the  girl's 
father,  and  a  few  others  who  testified  to  an  intimate  acquain- 
tance with  the  family.  The  principal  testimony  was  that  of 
Mary  E.  Ryan,  the  sister  of  the  sick  girl's  mother.  The  witness 
testified  that  she  slept  in  the  room  with  the  child.  The  latter 
was  in  the  third  trance  when  she  first  produced  the  '  angels.' 
Some  time  after  the  child  showed  her  the  box  in  which  they 
were  kept.  The  child  took  tliem  out  and  kissed  them.  Witness 
said  that  she  never  saw  any  thing  more  beautiful.  "They  had 
short,  curly  hair,  and  were  about  an  inch  long.'  The  child  said 
that    '  Frankie'   had   sent   them   to   her.      '  Frankie'   was   the 


1-J2  MEDICAL    JURISPRUDENCE. 

brother  who  had  died  and  for  years  before  his  death  was  an 
invaUd  requiring  constant  care.  This  witness  described  in  de- 
tail the  visits  of  Father  Fleming,  as  others  had  done.  The 
priest  refused  to  return  the  images  which  he  had  in  his  posses- 
sion, because  he  said  the  Church  condemned  idolatry,  and  at 
length  refused  to  have  any  thing  further  to  do  with  the  case, 
considering  that  some  bad  influences  were  at  work.  He  de- 
clared it  to  be  a  case  for  the  insane  asylum,  Carney  Hospital,  or 
the  Sisters.  This  witness  also  told  of  the  child  seeing  the  vision 
of  the  Immaculate  Conception  ! 

"  William  H.  Gannon,  the  father  of  the  child,  testified  at 
great  length  of  his  interviews  with  the  Archbishop,  and  his  re- 
peated demands  for  the  child's  images.  Concerning  the  effect 
of  the  priest's  course  upon  the  child,  he  said  that  she  held  her 
voice  until  April,  1880.  From  the  very  first  there  were  one  or 
two  persons  who  could  restore  her  voice  temporarily.  In  De- 
cember, 1880,  she  became  totally  speechless.  Then  for  a  time 
she  lost  her  sight  and  hearing.  After  a  while,  he  said,  the  thing 
got  into  the  papers  and  many  people  visited  the  house,  among 
them  some  Spiritualists.  People  made  it  a  point  to  see  if  some 
one  could  not  take  her  by  the  hand  and  restore  her  voice  alto- 
gether. When  Mr.  Fleming  took  her  by  the  hand  she  could 
speak.  They  managed  to  discover  a  means  of  rousing  her,  and 
she  recovered  her  eyesight  and  hearing  and  the  muscles  of  her 
neck  relaxed.  At  present  she  is  without  speech  and  cannot  be 
left  alone  ;  she  cannot  walk  more  than  a  quarter  of  a  mile  ; 
when  she  puts  her  head  on  a  pillow  she  goes  to  sleep  and  can- 
not be  roused.  She  will  not  be  left  alone,  and  she  manifests 
the  loss  of  her  angels  by  trying  to  speak  and  in  writing.  The 
want  of  them  has  a  very  depressing  effect  on  her.  The  witness 
declared  that  neither  he  nor  his  wife  had  any  idea  where  the 
images  came  from,  but  he  thought  the  child  was  under  a  delu- 
sion in  respect  to  their  supernatural  origin.  He  insisted  that 
Father  Fleming's  action  with  the  images  was  the  direct  occa- 
sion of  his  child's  extraordinary  troubles.  She  had  a  slight  de- 
lusion about  them  before  the  priest  came,  and  they  were  taker 
from  her  in  such  a  way  as  to  increase  the  delusion  By  proper 
management  of  her  case  he  believed  she  could  have  been  cured 
of  her  delusions. 

"  Dr.  M.  Hodges,  the  physician  who  attended  the  girl,  was 
called  and  testified.  }ler  disease  he  pronounced  to  be  j^ro- 
found  hysteria.  The  disease  would  probably  be  aggravated,  he 
thought,  if  she  were  surrounded  l)y  a  superstitious  atmosphere. 
One  of  the  traits  of  the  disease  was  to  deceive,  but  with  no  in- 


HYSTEROID    STATES    AND    BEIGNED    DISEASES.  1 73 

tent  on  the  part  of  the  patient  to  deceive.  He  thought  it 
dangerous  to  accept  as  facts  any  statements  made  by  a  person 
in  that  condition.  It  was  not  an  uncommon  phenomenon  for 
a  person  to  lose  power  of  speech  for  a  longer  or  a  shorter  time. 
He  advised  the  removal  of  the  child  from  her  surroundings,  but 
this  advice  was  not  followed  because  the  family  thought  they 
could  take  better  care  of  her  at  home.  He  was  not  prepared 
to  say  whether  the  possession  of  the  images  would  or  would  not 
increase  her  superstitious  delusion. 

''Dr.  Walter  Channing,  an  expert  witness,  was  of  the  opinion 
that  the  child's  condition  was  aggravated  by  the  action  of  the 
priest  and  that  it  produced  a  'moral  shock.'  " 

Hysteria  iu  Young  Children. — In  very  young  children 
even  the  presentation  of  hysterical  symptoms  is  often  very 
extraordinary.  Recent  and  excellent  illustrations  of  the  dis- 
ease originating  before  puberty  are  published  by  Dr.  Butlin, 
(London  Lancet,  Jan.  17,  187 1,  p.  819,)  who  reported  the  cases 
of  three  children  who  for  a  long  time  successfully  malingered 
so  as  to  deceive  their  parents.  The  first  of  these  cases  was 
a  girl  aged  seven  years,  who  successfully  simulated  epilepsy  and 
described  her  condition  with  great  enjoyment.  The  case  was 
cured  by  a  "few  sharp  smacks  with  a  wet  towel."  Rebecca 
N.,  aged  nine  and  a  half  years,  who  feigned  unconsciousness 
for  a  long  time.  She  closed  her  eyes  and  apparently  took  no 
notice  of  her  family  and  for  two  weeks  had  to  be  fed  with  a 
spoon.  She  would  not  get  up,  nor  stand  or  walk  and  was  a 
constant  source  of  trouble.  Her  father,  who  appeared  to  be  a 
sensible  man,  saw  her  get  up  and  get  something,  and  proposed 
firm  discipline,  but  the  mother  would  not  permit  it.  She  there- 
fore was  kept  at  home  and  kept  up  her  comedy  for  some  time, 
but  was  finally  sent  to  the  Children's  Hospital.  Dr.  Butlin  de- 
scribes her  progress  as  follows  : 

"  About  four  weeks  before  admission  her  bowels  were  consti- 
pated for  about  a  week.  At  the  end  of  that  period  she  again 
closed  her  eyes.  Since  then  she  had  never  opened  them  again, 
and  had  only  spoken  three  words.  She  could  not  stand,  and 
was  subject  to  '  dreadful  fits  of  trembling.'  Often  she  wept 
quietly.  She  seemed  to  understand  every  thing  that  was  said. 
Her  appetite  was  good.  She  was  said  to  be  a  remarkably  smart 
child.  Her  general  health  was  good  ;  her  bowels  were  regular  ; 
the  menses  had  not  appeared. 

"  On  admission  she  was  found  to  be  a  fairly  nourished  girl. 
She  had  a  receding  forehead,  but  her  features  were   strongly 


1^4  MEDICAL    JURISPRUDENCE. 

marked,  and  she  looked  considerably  older  than  she  was.  Her 
face  was  past}'.  She  lay  with  both  eyes  closed,  and  the  left 
hand  in  front  of  them.  The  under  lid  did  not  cease  to  quiver. 
The  right  hand  lay  across  the  chest,  but  raised  up  from  it,  and 
underwent  a  continual  shaking  or  vibrating  movement.  The 
legs  were  drawn  up  and  motionless.  When  the  left  hand  was 
removed  from  before  the  eyes  the  lids  quivered,  and  at  times 
also  the  sides  of  the  face,  the  movement  being  similar  to  that 
produced  by  galvanism.  Any  attempt  to  separate  the  lids  was 
strongly  resisted.  She  did  not  speak,  but  frequently  nodded  in 
reply  to  questions.  She  bore  a  remarkably  hard  pinch  on  the 
arm  or  leg  wiihout  flinching  or  crying  out,  but  the  shaking 
movements  were  increased,  and  the  tips  of  the  fingers  became 
covered  with  perspiration.  When  one  arm  was  held  the  shak- 
ing of  the  other  became  more  marked.  The  gums  were  spongy, 
the  lips  broken,  the  breath  offensive,  the  tongue  brown  and 
dry;  the  pulse  ii6and  regular.  She  had  a  short  hysterical 
cough.  The  inspirations  and  heart  sounds,  and  the  liver  and 
splenic  dullness,  were  normal.  The  bladder  was  distended, 
and  on  a  vessel  being  produced  she  passed  thirty-two  ounces  of 
urine,  acid  in  reaction,  of  a  specific  gravity  of  1020,  and  de- 
positing phosphates  on  being  heated.  She  was  ordered  two 
grains  of  calomel  and  ten  grains  of  jalap  powders  and  passed 
a  good  night. 

"On  the  following  day  she  cried  a  good  deal.  The  bowels  not 
having  acted,  the  powder  was  repeated,  and  was  followed  on 
the  third  day  by  copious  evacuations.  Whenever  she  awoke 
from  sleep,  however  suddenly,  the  eyes' remained  closed.  She 
Avas  ordered  to  have  a  shower  bath  every  other  morning,  and  a 
draught  consisting  of  eight  grains  of  chlorate  of  potassium,  a 
drachm  of  tincture  of  valerian,  and  half  an  ounce  of  the  infu- 
sion three  times  a  day.  An  aperient  powder  was  given  occa- 
sionally in  order  to  maintain  the  action  of  tlie  bowels. 

"  Day  after  day  passed  without  any  material  alteration  in  her 
condition,  until,  nn  the  fifteenth  day,  the  house  surgeon,  Mr. 
Sankey,  taking  a  galvanic  battery  to  her  bedside,  told  her  that 
it  had  become  absolutely  necessary  to  apply  it  until  she  re- 
covered the  power  of  speech.  Having  promised  that  as  soon 
as  she  had  distinctly  pronounced  the  word  'mother'  he  would 
desist,  he  proceeded  to  a])ply  the  sponges,  pausing  every  few 
seconds  to  demand  the  rc])etition  of  the  required  word.  After 
about  a  quarter  of  an  hour  the  girl's  |)atience  began  to  be  ex- 
hausted, and  she  broke  out  into  plaintive  sobbing.  The  appli- 
cation was  however  persevered  in  until,  at  about  the  end  of  half 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  1 75 

an  hour,  after  two  or  three  feeble  articulations,  she  distinctly 
pronounced  the  word.  From  that  time  her  cure  was  virtually- 
effected  ;  she  resumed  the  power  of  speech  ;  and  although,  on 
being  placed  out  of  bed  she  appeared  to  be  quite  unable  to 
stand,  in  the  course  of  the  afternoon  she  managed  to  walk  about 
the  ward  without  assistance.  Three  days  later  the  aid  of  gal- 
vanism was  again  resorted  to  to  induce  her  to  open  her  eyes. 
On  the  following  day  she  read  a  book  ;  in  two  or  three 
days  more  she  was  running  about  the  garden  with  the 
other  children,  and  was  shortly  after  discharged  in  good 
health." 

"  Case  3. — Florence  B. ,    aged   eleven  years,    ailing   for 

a  twelvemonth,  but  had  previously  been  a  perfectly  healthy 
child.  Her  first  symptoms  were  difficulty  in  walking  and  ina- 
bility to  hold  herself  upright.  Then  she  began  also  to  com- 
plain of  pains  in  the  stomach.  There  was  no  history  of  any 
injury.  During  the  last  five  or  six  months  she  had  been  grad- 
ually getting  worse,  until  she  lost  the  use  of  her  legs.  She  was 
not  able  to  hold  her  water  when  sitting  up.  Her  bowels  were 
never  open  without  injections.  She  still  complained  of  pains 
in  the  stomach  ;  but  had  very  little  pain  in  the  back  except 
when  she  was  moved.  Her  appetite  was  very  good,  and  she 
was  in  fair  general  health. 

"  When  brought  into  the  hospital  she  was  fairly  nourished,  but 
emiited  a  peculiar  mousy  odor,  similar  to  that  sometimes  ob- 
served in  the  insane.  She  was  obviously  very  hysterical,  calling 
out  as  if  in  pain  whenever  and  wherever  touched.  She  knew  a 
great  deal  about  what  had  been  the  matter  with  her,  and  re- 
membered what  the  doctor,  at  home,  said  about  'her  com- 
plaint.' Her  tongue  was  clean,  pulse  100,  and  face  pale.  She 
passed  water  without  difficulty.  Her  appetite  was  good,  and 
she  slept  well,  but  generally  with  legs  drawn  up.  She  com- 
plained of  pain  and  tenderness  in  the  abdomen.  Her  legs 
were  fairly  nourished,  and,  on  measurement,  were  found  to  be 
of  equal  size.  Her  feet  were  cold.  When  made  to  walk  she 
raised  her  legs  slowly  and  with  apparent  difficulty.  Sensation 
appeared  to  be  still  more  impaired  than  motion,  for  she  took 
little  or  no  notice  when  the  feet  and  legs  Avere  punched  or 
pricked.  No  reflex  movements  could  be  excited.  A  sharp  tap 
on  the  sole  of  the  foot  caused  pain  in  the  abdomen,  but  very 
little  in  the  back.  On  examining  the  back,  a  very  slight  lateral 
curvature  to  the  right  side  seemed  to  exist  in  the  lower  dorsal 
and  lumbar  regions,  and  some  tenderness  over  the  fourth  and 
fifth  lumbar  vertebra  ;  but  no  prominence  could  be  observed 


176  MEDICAL    JURISPRUDENCE. 

either  in  this  or  any  other  part  of  the  spine.  She  preferred  to 
lie  on  the  left  side. 

"  Although  Mr.  Smith  suspected  that  her  ailment  was  hysteria, 
he  thought  it  safer  to  commence  treatment  as  if  her  symptoms 
were  due  to  a  more  natural  cause.  He  therefore  gave  direc- 
tions for  the  legs  to  be  galvanized  daily,  and  ordered  two 
minims  of  the  liquor  strychniae  in  two  drachms  of  steel  wine  to 
be  taken  three  times  a  day,  as  well  as  a  pill  containing  a  third 
of  a  grain  of  extract  of  aloes,  two  grains  of  compound  rhubarb 
])ills,  and  a  sixth  of  a  grain  of  nux  vomica,  to  be  taken  once  a 
day.  In  about  a  fortnight  she  sat  up  in  bed,  having  been 
promised  that  as  soon  as  she  could  stand  she  should  walk  in 
the  garden.  She  com])lained  of  very  little  pain  either  in  the 
abdomen  or  back  ;  her  bowels  were  regular,  and  the  expression 
of  resignation  which  her  face  had  worn  was  replaced  by  a 
bright  and  cheerful  look.  At  the  same  time  she  seemed  to 
recover  sensation  in  her  legs,  and  for  the  first  time  gave  evi- 
dence of  feeling  the  galvanic  battery.  On  the  twenty-eighth 
day  she  began  to  walk  about,  and  was  very  bright  and  talkative. 
On  the  thirtieth  she  walked  quite  firmly  and  without  any  pain  ; 
she  complained  of  no  pain  in  the  abdomen,  and  of  very  Uttle  in 
the  back.  On  the  thirty-second  day  she  was  running  about 
the  garden  playing  with  other  convalescents,  and  in  a  few  days 
more  was  discharged." 

Hysterical  Simiilatiou  of  Real  Diseases. — It  is  quite 

common  for  hysteria  to  simulate  real  diseases.  The  so-called 
neuro-viimeses  includes  those  disorders  which  are  counterfeited 
in  the  hysterical  subject,  and  often  in  a  manner  to  deceive  the 
most  observant.  The  involuntary  expression  of  suffering  is 
often  free  from  any  tinge  of  dishonesty  upon  the  part  of  the 
patient.  We  find  simulated  joint  and  spinal  affections  which 
resist  all  remedies,  and  only  disappear  when  moral  treatment  is 
attempted.  A  young  woman  recently  came  under  my  charge 
complaining  of  "  rheumatism  "  and  "  spinal  disease."  She  had 
worn  a  complicated  s])inal  brace,  and  had  used  embrocations  for 
the  knee.  Vv'hen  I  removed  the  former  I  found  no  disease  of 
the  vertebral  column  whatever,  as  evinced  by  external  appear- 
ance, and  the  rheumatic  knee,  "  u])on  which  she  could  not  bear 
her  own  weiglit  "  was  not  swollen,  red,  tender,  nor  could  I  detect 
any  sign  of  rheumatism.  In  this  order  of  hysterical  troubles 
belong  the  contractura  and  i)aralyses.  The  lay  observer  may 
often  have  his  sympathies  aroused  ])y  the  appearance  of  the 
deformed  patient.     When  such  manifestations  are  claimed  to 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  1 77 

be  tb..  resul*:  o'  in-"ur}.the  examination  of  the  medical  man 
cannot  bf  too  searching  or  sure^  for  often  there  are  just  suffi- 
cient indications  of  or^^anic  trouble  to  mislead.  It  should  not 
be  forgotten  tba*:  these  hysterical  contractions  are  comparatively 
rare  among  mea,  that  in  women  they  are  usually  connected 
with  ovarian  neuralgia  and  spinal  pain  ;  that  the  contraction  is 
m_odified  by  diversion  o";  the  attention,  thac  the  mental  condi- 
tion if  peculiar,  and  wc  are  to  look  out  for  great  self-absorption 
and  diverted  emotions. 

The  influence  o/  self-concentration  in  the  production  of  dis- 
ease is  recognized  by  all  who  have  occasion  to  treat  nervous  peo- 
ple. The  maladies  in  men  are  not  serious  and  rarely  arise  above 
the  level  of  gastric  disorder,  but  often  an  intractable  voluntary 
paralysis  may  be  due  to  this  complete  concentration  of  the 
patient'"  attention  upon  some  particular  trouble. 

Wynter,*  in  his  clever  little  book  discusses  the  possibilities  of 
morbid  attention.  "  There  is,  however,  a  certain  morbid  atten- 
tion, when  directed  towards  supposed  ailments  of  the  body  and 
mind,  which  i=  to  be  especially  deprecated.  A.  man  may  so 
concentrate  his  attention  upon  certain  organs  of  the  body  as  to 
create  disease  in  them.  The  hypochondriac,  for  instance, 
never  ceases  to  dwell  upon  the  condition  of  his  digestive 
organs,  and  the  consequence  is  that  he  directs  so  much  nervous 
energy  to  the  spot  as  to  cause  congestion  and  actual  disease. 
We  see  no  reason  to  doubt  that  mere  disordered  functions  of 
the  brain  may  be  converted  by  the  same  undue  attention  into 
positive  disorganization  and  mental  disease.  Hence  overstudi- 
ousness  on  these  points  is  to  be  avoided.  In  the  majority  of 
cases  there  is  no  danger  of  such  a  result,  but  in  a  person  of  a 
highly  nervous  temperament  it  is  different,  and  with  them  the 
very  first  step  towards  health  would  be  to  enable  them  to  get 
rid  of  themselves." 

Paget,  f  who  has  with  Skae  called  attention  to  the  hysterical 
production  of  real  disease,  thus  speaks  of  the  "  nervous-mimi- 
cries "  : 

"  Some  mimicries  are  essentially  mental  ;  such,  for  instance, 
as  those  in  which  patients,  out  of  mere  fear  and  keen  attention, 
acquire  the  pains  of  cancer,  and  localize  them  in  healthy  parts  ; 
and  as  nearly  all  mimicries  or  mental  influence  may  be  dis- 
cerned, just  as  it  may  in  nearly  all  real  diseases  in  which  con- 
sciousness  remains.     An    influence  impossible   to  separate  or 

*  Borderlands  of  Insanity,  p.    22. 
\  London  Lancet,  vol.  2,  1S72,  p.  513, 
12 


178  MEDICAL    JURISPRUDENCE, 

weigh,  generally  increasing  with  the  duration  of  the  disease, 
yet  not  essential  to  it,  whether  it  be  real  or  mimic.  But  in  all 
mimicries  it  is  hard  to  discern  any  mental  influence  at  all. 
Some  are  imitations  of  disease  very  far  from  mental  associa- 
tions— the  cases,  for  example,  of  intestinal  distention,  constipa- 
tion of  many  days' duration,  constant  .vomiting  and  apepsia, 
rapid  heart's  action  with  slow  breathing,  largely-pulsating 
arteries  and  phantom  tumors.  Some  are  found  in  common- 
place, ignorant  and  slow-minded  people  who  never  saw  or 
heard  of  the  diseases  imitated  in  them.  Some  occur  in  chil- 
dren who  could  neither  imagine  nor  act  what  they  tell  and 
show,  though  as  they  grow  up  they  may  become  those  in  whose 
successive  mimicries  the  mental  influence  takes  a  constantly 
increasing  part.  And,  to  end,  whatever  may  be  ascribed  to 
mental  influence,  it  can  produce  mimicry  of  organic  disease  in 
only  certain  persons  whose  nervous  organs  seem  wholly  prone 
to  this  manner  of  disorder,  and  whose  spinal  and  ganglionic 
systems  must  be  deemed  erroneous,  as  well  as,  or  more  than, 
their  brains.  For  nervous  mimicry  is  not  very  frequent  among 
the  evidently  insane,  and  among  the  sane  there  are  many  who 
cannot  bring  about  a  mimicry  of  disease  by  any  effort  of  im- 
agination or  direction  of  the  mind.  Among  these  I  am  happy 
to  count  myself.  I  have  tried  many  times  carefully,  and  with 
good  opportunities,  but  have  always  failed." 

There  are  some  physical  symptoms  that  may  appear  dubious, 
an  occasional  blunting  of  electric  reaction,  and  the  continuance 
of  the  tendinous  reflex.  The  skin  of  the  anesthetic  patient  is 
sometimes  anesthetic  and  the  sensory  tests  are  blunted  accord- 
ingly. In  cases  where  the  tendinous  reflex  is  exaggerated  it 
will  be  found  that  there  has  been  well  matured  hysterical 
paralysis  for  some  time,  and  that  the  clonus  of  the  heel  is  much 
greater  than  in  any  form  of  myelitic  paralysis,  and  there  is  no 
atrojjhy.  When  an  anesthetic  is  administered  there  is  a  dis- 
appearance of  the  contracture  in  cases  of  hysterical  paralysis. 

Hysterical  Traumatic  Contractures. — Charcot  has  de- 
voted mucli  attention  to  the  consideration  of  imitative  hysteria, 
of  the  kind  alluded  to,  and  in  a  late  paper  has  called  attention 
to  the  contractures  of  traumatic  origin  that  may  often  be  wit- 
nessed. It  is  possible  that  we  may  be  required  to  make  a  dis- 
tinction in  accident  cases  between  cicatricial  contraction  as  a 
result  of  nerve  wounding,  and  that  of  a  more  substantial  sort 
where  perhaps  a  superficial  wound  has  been  made,  and  where 
hysteria  causation  may  give   rise   to  a  deformity,  which  may, 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  1 79 

however,  be  recognized  if  proper  tests  are  made.  Charcot  re- 
fers to  several  young  people  who  received  slight  wounds,  in 
themselves  not  being  sufficient  to  cause  contracture  from  tissue 
changes,  but  where  there  was  undoubted  deformity,  and  the  oc- 
currence of  general  hysterical  symptoms,  such  as  convulsive 
crises.  One  of  his  cases  is  that  of  a  girl  of  sixteen,  of  frail 
appearance,  who  is  "  placidly  hysterical."  She  is  an  orphan, 
and  after  her  mother's  death,  which  was  from  consumption,  she 
entered  a  religious  institution,  and  afterwards  came  under  the 
care  of  Charcot.  There  was  a  history  of  hereditary  insanity 
in  her  case,  her  father  having  died  of  general  paresis,  and  she 
had  an  idiot  brother.  She  had  never  had  hysterical  convul- 
sions, but  mentally  shows  a  certain  weakness  and  wantonness. 
Her  left  hand  is  the  seat  of  a  deformity  which  has  lasted  for  a 
year,  but  has  lately  become  less  pronounced.  "The  wrist  is 
free  ;  it  is  the  same  with  the  other  articulations  of  the  superior 
extremity.  The  first  phalanges  are  bent  upon  the  metacarpus. 
The  other  phalanges  present  but  a  slight  degree  of  flexion. 
The  fingers  thus  uniformly  bent,  are  crowded  together,  forming 
a  sort  of  cone,  of  which  the  summit  corresponds  with  the  ex- 
tremity of  the  last  phalanx.  The  thumb,  in  adduction,  is 
strongly  forced  against  the  index  finger.  It  is  easy  to  convince 
ourselves  that  muscular  rigidity  is  the  sole  cause  of  this  deform- 
ation, and  that  the  articulations  and  the  ligaments  are  not 
affected.  Attempts  at  reduction  show  this  sufficiently.  Chlo- 
roformization  would  give  us  peremptory  proof  of  it,  but  we 
have  feared  any  perturbation,  which  would  prevent  us  from 
studying  this  deformation  de  visu.  On  the  other  hand,  we  find 
here  the  characteristics  of  the  spasmodic  contractura.  If  in- 
deed the  flexors  are  the  most  affected,  and  determine  the  im- 
port of  the  deviation,  the  extensors  are  also  involved  ;  for  it  is 
as  difficult  to  exaggerate  the  flexion  as  to  produce  the  exten- 
sion. This  simultaneous  action  of  the  antagonistic  forces  is 
one  of  the  characteristics  of  spasmodic  contractura.  *  *  * 
The  deformed  hand  is  colder  than  the  other,  and  shows  a  some- 
what marked  bluish  tint,  denoting  a  manifest  trouble  of  the 
vaso  motors.  There  is  atrophy,  or  rather  a  slight  emaciation, 
not  only  of  the  hand,  but  also  of  the  other  segments  of  the 
limb.  The  forearm  and  the  upper  arm  are  a  centimeter  less  in 
circumference  than  in  the  opposite  member  ;  it  is  not  a  ques- 
tion of  veritable  muscular  atrophy,  but  of  emaciation  due  to 
prolonged  repose.  We  find  besides  a  diminution  of  general 
and  special  sensibility  upon  the  entire  half  of  the  body  in 
which  the  deformation  exists."     In  this  case,  as  well  as  others, 


i8o 


MEDICAL   JURISPRUDENCE. 


we  are  likely  to  detect  limitation  of  the  visual  field,  and  hemi- 
anesthesia, and  the  contracture  itself  is  peculiar  ;  and  in  other 
hysterical  patients,  where  there  is  no  suspicion  of  injury,  it  is 
])ossible  to  produce  it  by  excitations  of  various  kinds.  There 
IS  often  some  ovarian  trouble,  and  one  of  the  peculiarities  of  the 
deformity  which  Charcot  strongly  insists  upon,  is  the  perma- 
nence and  persistence  of  the  contracture,  which  is  different  from 
that  of  hemiplegia  or  that  due  to  any  other  organic  change,  for 
in  hemiplegia,  as  well  as  in  sclerosis,  there  is  some  relaxation 
(luring  sleep.  In  this  case  the  wound  was  of  the  most  insig- 
nificant kind,  the  patient  receiving  more  than  a  year  before  a 
slight  scratch  ui)on  the  back  of  the  hand  over  the  second  meta- 
carpal bone,  which  healed  in  four  or  five  days.  The  develop- 
ment of  the  contracture  was  sudden  and  unattended  by  pain, 
and  persisted  a  long  time  after  the  healing  of  the  wound.  The 
contracture  differed  from  that  which  we  might  expect  from  or- 
ganic brain  disease  from  the  fact  of  its  sudden  appearance, 
and  although  Charcot  points  out  the  fact  that  in  descending 
cerebral  or  spinal  sclerosis  we  may  find  the  same  condition 
produced  as  the  result  of  a  traumatism,  "  there  is  not  the  same 
disproportion  between  the  lightness  of  the  traumatic  injury  and 
the  intensity  of  the  contracture,  which  has  no  longer  the  same 
persistency  after  the  cure  of  the  peripheral  irritation." 

Charcot  suggests  certain  tests  for  the  detection  of  simulated 
contracture  and  that  which  undoubtedly  originates  in  hysteria. 


Fig-  4- 


For  this  purpose  he  applies  the  myographium,  and  after  attach- 
ing a  weight  to  the  end  of  the  fingers  of  the  contracted  hand, 
it  is  found  that  in  the  diseased  state  the  contracture  is  not  over- 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  iSl 

come  until  the  end  of  twenty  or  twenty-five  minutes,  the  de- 
scent of  the  fingers  being  accompanied  by  slight  tremor  of  a 
regular  character,  while  the  simulator  is  unable  to  keep  his  hand 
in  the  same  position  for  anything  like  the  time  above  mentioned. 
I'he  most  satisfactory  test  however,  is  that  which  depends 
upon  the  respiratory  effort  upon  the  part  of  the  simulator  in 
his  attempt  to  preserve  the  position  of  the  hand.  Fig.  5  shows 
tracings  made  by  means  of  the  myographium,  A.  B.  being  those 
of  a  patient ;  and  C.  D.  those  of  the  simulator. 


Fig.  5- 

In  courts  of  law  the  existence  of  this  hysteroid  state  may 
prove  to  be  an  important  factor  ;  and  it  will  not  do  to  take  an 
unscientific  view  of  the  patient's  state,  although  it  may  be 
urged  that  the  hysterical  condition,  especially  if  it  reaches  the 
dignity  of  a  diseased  condition  in  which  hemi-anesthesia  with 
visual  defects  and  convulsive  seizures  are  expressed,  may  in- 
fluence our  judgment  in  arriving  at  a  conclusion  as  to  the  sus- 
ceptibility of  the  patient  to  slight  injuries  ;  the  responsibility 
of  the  defendant  in  such  cases  might  be  limited  by  the  dys- 
crasia  of  the  plaintiff,  and  we  cannot  consider  the  case  of  a  per- 
son presenting  contracture  of  this  kind  as  the  result  of  an  in- 


1 82  MEDICAL    JURISPRUDENCE. 

jury  due  to  the  carelessness  of  the  defendant  as  we  would 
where  a  perfectly  strong,  vigorous  person  presented  a  tissue 
change  with  contracture,  as  the  result  of  mechanical  nerve 
lesion.  It  may  be  wise  to  regard  with  suspicion  cases  of 
slight  contracture  without  nerve  wounding,  or  descending 
neuritis  among  men,  for  so  far  the  reported  cases  of  pronounced 
traumatic  hysterical  contracture  have  occurred  among  nervous 
women. 

Epidemic  Hysteria. — Considerable  medico-legal  interest 
arises  in  cases  of  epidemic  hysteria,  and  we  find  that  some 
persons  who  may  be  thrown  together  may  present  a  peculiar 
form  of  hysterical  trouble.  In  this  condition  a  variety  of  pur- 
poseless violent  acts  and  breaches  of  the  peace  may  be  com- 
mitted by  individuals  under  the  influence  of  religious  excite- 
ment. Hecker  refers  to  a  peculiar  hysterical  condition  which 
existed  in  the  fifteenth  century  among  the  German  nuns  who 
fell  to  biting  each  other,  and  the  epidemic  spread  so  that 
eventually  every  religious  order  in  Europe  followed  the  ex- 
ample of  the  nuns  of  Saxony  and  Brandenburg.  The  sexual 
excitement  which  grew  out  of  the  gatherings  resulted  in  all 
manner  of  outrages  upon  public  decency.  Many  of  the  sub- 
jects exposed  themselves  in  a  most  indecent  manner,  tore  their 
hair  and  went  howling  about  the  country.  It  is  probable  that 
as  a  result  of  the  freedom  from  restramt  and  religious  excite- 
ment inseparable  from  camp-meeting  and  revivals  a  morbid 
sexual  state  exists  which  leads  to  the  commission  of  acts 
that  might  often  form  the  basis  of  medico-legal  inquiry. 

I  have  known  of  one  isolated  and  clear  example  of 
epidemic  hysterical  insanity  in  which  two  members  of  an  unfor- 
tunate family  became  the  subjects  of  a  condition  bordering  upon 
hysterical  mania.  An  hysterical  girl  was  taken  to  the  moun- 
tain for  her  health,  but  no  benefit  was  derived  from  the  change 
and  she  grew  more  violent  and  unreasonable.  Her  mother, 
and  a  sister  very  nearly  her  own  age,  were  her  companions  and 
constant  nurses.  Upon  their  return  journey  to  New  York 
the  sister  showed  an  unnatural  excitement  which  developed 
before  they  reached  Troy  into  a  veritable  hysterical  mania. 
They  became  so  raving  and  violent  that  the  hotel  proi)rietor  in 
that  city  turned  them  out  of  his  house  and  put  them  on  the 
cars,  but  in  Albany  they  again  rested,  and  their  sad  condition 
being  mistaken  for  drunkenness,  they  were  arrested,  but  were 
finally  released  and  again  began  their  journey  to  New  York,  the 
mother  being  now  in  a  partially  responsible  state  as  she  was  half 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  183 

crazed  by  the  excitement  and  disgrace.  They  finally  reached 
New  York  and  went  to  a  hotel  where  they  staid  for  a  night  only 
as  one  of  the  sisters  tried  to  force  her  way  through  the  fan- 
light over  the  door  of  her  room  and  so  alarmed  the  guests  that 
the  police  were  called  in  and  they  were  arrested  and  taken  to 
Headquarters.  They  were  removed  by  some  friends  and  I 
subsequently  examined  them.  The  mental  disorder  in  this 
case  was  sexual  and  it  became  so  much  worse  that  the  patients 
were  finally  sent  to  an  asylum. 

In  such  cases  as  this  the  question  of  responsibility  is  an  inter- 
esting one,  and  it  was  evident  that  the  final  action  of  the 
Albany  judge  who  first  thought  the  patients  intoxicated,  and 
afterwards  sent  them  out  of  town,  went  to  show  that  the 
behavior  of  the  girls  was  not  looked  upon  as  criminal. 

Hysteria  with  Destructive  Tendencies. — A  form  of 
hysteria  bordering  upon  insanity  which  is  happily  rare  is  that 
in  which  the  individual  wantonly  destroys  the  clothing  of  other 
people.  This  he  does  by  means  of  sharp  irtstruments,  vitriol 
and  other  corrosive  substances.  I  know  of  one  case  of  this 
kind,  the  individual  presenting  undefined  symptoms  of  intel- 
lectual disturbance.  He  has  several  times  been  arrested  how- 
ever for  secretly  pouring  sulphuric  acid  upon  the  dresses 
of  ladies  in  crowded  thoroughfares.  Ogston  refers  to  the 
"  Piquers,"  a  class  of  men  who  wantonly  cut  the  clothes  of 
women  in  the  streets  of  Paris.  He  however  believes  as  I  do, 
that  in  a  number  of  cases  a  motive  can  be  assigned  for  these 
acts,  and  alludes  to  two  cases — one  that  of  a  young  woman 
who  manifested  a  tendency  to  break  windows,  and  an- 
other that  of  a  man  who  amused  himself  by  slyly  snipping 
ladies'  dresses  with  a  small  pair  of  scissors.  In  the  latter  case 
beyond  a  taciturn  misanthropic  disposition  and  a  slight  de- 
gree of  imbecility  no  mental  alteration  was  discernible. 

The  Desire  for  Notoriety.— There  are  various  other 
species  of  deviltry  that  are  sometimes  the  expression  of  a  peculiar 
mental  state  which  may  be  called  hysterical.  The  case  of  "  Gen- 
tleman Jo,"  a  miserable  weak  creature  who  created  a  sensation 
throughout  the  country  by  anonymous  letter  writing,  is  well 
known.  One  very  well-known  clergyman  of  New  York  was 
kept  in  a  constant  state  of  annoyance  by  the  receipt  of  several 
hundred  letters  and  scurrilous  postal  cards  within  a  few  weeks 
which  led  to  the  most  humiliating  contretemps.  It  was  supposed 
at  first  that  the  motive  of  the  writer  was  blackmail,  but  though 


r84  MEDICAL    JURISPRUDENCE. 

one  postal  card  intimated  something  of  the  kind,  such  a  con- 
clusion under  the  circumstance  was  absurd  and  out  of  the 
question.  The  man  was  detected  and  taken  to  the  Tombs, 
where  I  examined  him.  I  found  him  to  be  of  the  insane  tem- 
perament and  of  decided  weak,  hysterical  mind.  He  was  con- 
sumed with  a  vanity  and  desire  for  notoriety  which  I  have  only 
seen  equaled  in  the  case  of  Guitear.  the  assassin.  He  presented 
well  marked  hypochondriasm  with  sexual  perversion,  and 
there  was  no  motive  for  the  letter  writing.  Coupled  with 
various  indications  of  moral  depravity,  he  was  a  petty  thiefv 
He  was  found  guilty  and  sent  to  state  prison  where  he  subse- 
quently died. 

Winslow  refers  to  the  case  of  a  man  arrested  and  convicted 
of  murder,  who  was  unquestionably  of  the  class  to  which  these 
two  men  belonged,  and  the  same  degree  of  nauseating  desire 
for  notoriety  was  exliibited  : 

"  While  in  the  cell  at  the  Town  Hall,  he  was  gratified  when 
by  his  mimicry  or  other  means,  he  could  attract  the  attention  of 
persons  in  the  office  above.  When  being  taken  out  on  Mon- 
day, he  anxiously  inquired  whether  there  were  a  good  many 
people  standing  outside,  intimating  that  he  should  shout  out  to 
them  if  there  were  ;  and  on  finding  nobody  standing  about, 
he  exhibited  much  disappointment.  While  in  the  cab,  and 
also  after  being  placed  in  the  railway  carriage,  he  persisted  in 
sitting  close  to  the  window,  and  seemed  pleased  at  the  slightest 
notice.  His  utter  insensibility  of  the  awfulness  of  the  crime 
which  he  has  committed,  is,  however,  most  strikingly  illustrated 
by  a  piece  of  shocking  levity  in  which  he  also  indulged  in  on 
Sunday.  The  attention  of  several  of  the  police  officers,  who  were 
in  the  receiving  office,  was  attracted  by  Ijursts  of  merriment  from 
the  prisoners,  and  on  looking  in  the  cell-yard,  the  officers  saw 
H.  standing  in  a  stiff  upright  position,  slowly  turning  his  head 
backwards  and  forwards.  In  reply  to  an  inquiry  what  it  all 
meant,  the  prisoner  said  :  '  I  am  only  showing  them  how  I  shall 
look  in  wax  work  next  fair.'  This  performance  he  went  through 
a  number  of  times  during  the  day,  comj^lying  unhesitatingly 
with  every  request  to  show  them  again." 

'I'he  moral  perversion  which  is  attended  by  the  commission 
of  impulsive  acts  by  emotional  persons  of  feeble  will  is  sugges- 
tive of  an  advanced  degree  of  hysteria,  which  occupies  an  un- 
defined "borderland  "  between  ordinary  hysteria  and  actual  in- 
sanity of  a  definable  type.  Sucli  cases  are  those  which  try  the 
alienist  who  attem])ts  to  say  how  far  the  mental  condition  inter- 
feres with  responsibility. 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  185 

Aboniinaljle  Crimes. — Certain  conspicuous  degenerate 
moral  states  in  connection  with  liysteria  as  well  as  insanity  are 
manifested  in  sexual  disturbances  which  lead  the  unhappy  pa- 
tient to  commit  crimes  of  the  most  beastly  and  brutal  description. 
I  cannot  but  believe  that  a  congenital  state  of  mental  weak- 
ness is  at  the  bottom  of  much  of  the  unnatural  impulses. 
It  is  difificult  to  conceive  that  the  vile  assaults  upon  chil- 
dren, and  the  peculiar  inversion  of  the  sexual  feeling,  arises 
from  any  thing  else  than  a  congenital  defect  ("  imbecility  " — 
perhaps,  for  want  of  a  better  name)  which  has  hysteroid  mani- 
festations, and  a  survey  of  the  police  court  registers  of  a  large 
city,  will  disclose  cases  of  the  most  interesting  kind.  In  New 
York  are  a  large  number  of  unfortunate  men  who  prowl  about 
the  public  squares  at  night  soliciting  members  of  their  own  sex. 
These  men  delight  to  dress  in  women's  clothes  and  masquerade 
in  the  streets.  The  case  of  Lord  Clinton  in  London  was  sup- 
posed to  be  almost  unique,  and  the  subject  was  considered  too 
filthy  for  discussion  in  the  English  papers.  In  this  city  during 
the  past  few  years  I  am  informed  by  one  of  the  most  intelligent 
police  judges  that  a  great  many  arrests  have  been  made  for 
violations  of  public  decency,  and  no  less  than  six  of  these  were 
within  the  past  year  of  men  dressed  in  women's  clothes  who 
were  engaged  in  soliciting  for  a  purpose  too  vile  to  mention. 
This  sexual  inversion  has  been  described  by  several  German 
writers.  The  prisoners  are  usually  young  men  of  mincing  gait 
and  manner,  with  soft  high  voices,  wide  lips  and  large  thyroid 
cartilages. 

Pretended  Suicide  with  Hysteria — Pretended  attempts 

at  suicide  are  quite  common  among  hysterical  females.  Every 
general  practitioner  has  met  with  such  cases,  and  sometimes  it 
may  be  a  woman  who  keeps  her  household  in  a  state  of  terror 
by  threats  she  never  intends  to  consummate.  Such  cases  as  the 
following  reported  by  Ogston,  are  not  of  infrequent  occurrence. 
This  author  speaks  of  "a  young  married  female,  in  the  seventh 
month  of  pregnancy,  who  was  discovered  to  be  secretly  ad- 
dicted to  dram-drinking.  Annoyed  at  being  detected,  she 
pretended  to  be  very  ill,  and  to  have  swallowed  arsenic  to  destroy 
herself.  It  was  found  that  she  had  bought  three  drachms  of 
this  poison,  and  a  small  quantity  was  found  in  the  bottom  of  a 
teacup  in  which  she  said  she  had  mixed  it.  The  remainder  of 
the  powder  had  been  put  away.  The  mildness  of  the  symp- 
toms, however,  and  the  composure  with  which  she  complained 
of  her  tortures,  led  her  friends  to  suspect  that  she  was  feign- 


1 86  MEDICAL    JURISPRUDENCE. 

ing.  When  examined  by  Christison,  he  could  discover  no 
proof  of  poisoning,  and  her  statements  and  answers  to  ques- 
tions were  such  as  to  negative  the  fact  of  arsenic  having  been 
taken.  She  gradually  recovered  from  some  febrile  symptoms 
which  were  present,  and  in  two  days  admitted  that  she  was 
quite  well,  but  continued  to  insist  that  she  had  taken  the 
poison." 

"In  July,  1838,  H.  J.,  set.  25,  went  into  a  drug  shopan 
Union  Street  (Aberdeen),  to  purchase  an  ounce  of  laudanum. 
Suspecting  a  suicidal  purpose,  the  shopkeeper,  instead  of  laud- 
anum, gave  the  woman  an  ounce  of  tincture  of  rhubarb,  which, 
without  the  cheat  being  detected,  was  swallowed  on  the  spot. 
She  then  went  to  a  second  drug  shop  in  the  same  street,  with 
the  intention  of  procuring  a  second  dose  of  what  she  had 
asked  for  previously.  She  was,  however,  followed  by  the  first 
druggist  and  handed  over  to  the  police.  When  seen  soon  after 
at  the  police  ofhce,  the  woman  appeared  to  be  excited,  but 
manifested  at  times  a  strong  desire  for  sleep,  though  the  pupils 
were  not  contracted  and  the  pulse  was  strong.  Two  hours 
afterwards,  in  spite  of  attempts  to  keep  the  patient  awake,  she 
had  fallen  into  a  deep  sleep.  Conceiving  on  this  that  it  was 
possible  that  the  woman  had  had  the  opportunity  of  taking 
laudanum  before  swallowing  the  rhubarb,  though  the  pupils 
remained  natural,  the  contents  of  the  stomach  were  drawn  off 
by  the  pump,  but  exhaled  only  a  slightly  spirituous  odor." 

One  lady  I  knew  went  to  a  strange  hotel  in  an  obscure, 
back  street,  wrote  several  letters,  telegraphed  to  her  husbafid,  and 
upon  his  arrival  pretended  to  have  poisoned  herself,  alleging 
as  her  motive  his  cruel  treatment  and  his  attentions  to  other 
women,  of  both  of  which  he  was  innocent.  She  finally  re- 
covered after  imparting  to  me  the  fact  that  she  had  taken 
nothing. 

Self- Mutilation  by  Hysterical  Patients. — Self-mutila- 
tion is  an  occasional  feature  of  hysteria,  and  possibly  may  in- 
volve legal  complications.  Especially  is  such  the  case  in  suits 
for  damages  subsequent  to  recovery.  Helen  Miller,  whose 
case  is  reported  by  Dr.  Channing,*  came  under  my  observation 
some  years  ago.  She  had  committed  thefts  from  doctors' 
offices,  and  was  arrested  and  sent  to  prison.  While  there  she 
began  to  feign  insanity,  and  was  sent  to  the  Asylum  for  Insane 
Criminals.  She  had  been  of  hysterical  habits,  had  eaten 
opium,  and  was   treated  by  one   of    the  physicians   she   had 

*  Am.  Journal  oj  Insanity,  January.  1878,  p.  368. 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  187 

robbed,  for  dysmenorrhoea.  Her  first  exploit  in  the  asylum 
was  to  prick  her  gums,  and  the  blood  therefrom  was  mixed 
with  urine  and  crumbled  bread — so  that  an  attack  of  hema- 
temesis  was  suggested.  She  had  several  attacks  of  hysterical 
dysmenorrhoea,  was  irritable,  depressed,  and  had  fits  of  temper, 
'I'hen  she  began  a  system  of  self-mutilation  which  was  some- 
thmg  extraordinary.  At  various  times  she  thrust  pieces  of  glass, 
splinters  and  other  things  into  various  parts  of  her  body  ;  cut 
herself  with  pieces  of  tin  and  a  broken  bottle.  Upon  one 
occasion  she  broke  her  chamber  over  her  head.  Dr.  Channing 
removed  no  less  than  ninety-four  pieces  of  glass,  thirty-four 
splinters  of  wood,  two  tacks,  four  shoe  nails,  one  pin  and  one 
needle,  at  various  times.  In  this  case  the  woman's  pride  seemed 
to  be  that  she  was  the  object  of  surgical  interest  and  of  sympathy. 
I  saw  her  after  her  transfer  to  the  Blackwell's  Island  Asylum, 
where  she  was  sent  after  her  second  arrest  for  theft,  as  she  had 
been  discharged  from  the  Auburn  Asylum  when  her  first  sen- 
tence had  expired.  She  was  hysterical,  but  I  found  no  real 
intellectual  derangement,  and  I  should  not  consider  her  legally 
insane. 

A  case  is  reported  by  Mr.  Ferguson,*  the  patient  being  a 
woman  in  St.  Bartholomew's  Hospital. 

M.  W.,  a  fresh  colored,  artless  looking  girl,  spare  but  not 
badly  nourished,  was  admitted  into  the  hospital  with  the 
following  history  :  About  four  years  ago  she  was  subject  to 
fainting  fits,  but  has  never  appeared  very  excitable.  Accord- 
ing to  her  own  account  she  had  a  fall  last  July  whilst  in 
service,  by  which  her  left  knee  was  injured,  and  was  for  some 
time  exceedingly  painful.  In  this  condition  she  was  sent  home, 
and  the  knee  Avas  then  poulticed.  After  a  day  or  two  a 
needle  was  seen  protruding  over  the  patella;  this  her  mother 
removed.  As  the  knee  was  now  better  she  returned  to  her 
situatic"  ;  but  in  about  a  fortnight,  the  same  again  commen- 
cing to  distress  her,  she  was  again  sent  home,  and  before  long 
five  needles  were  removed  from  the  same  situation.  After  a 
short  time  the  arms  and  legs  became  similarly  affected. 
Things  proceeding  after  this  fashion,  loi  needles  and  pins, 
many  of  large  size,  curiously  twisted  and  deeply  imbedded, 
were  removed  by  her  usual  medical  attendant,  Mr.  Wicksteed, 
of  Walthamstow.  Although  some  years  ago  she  had  a  habit 
of  swallowing  strange  things — pieces  of  paper  and  the  like — ■ 
she  is  sure  she  never  swallowed  any  pins  or  needles,  and  can- 

*  London  Lancet,  July  20,  1872,  p.  78, 


l88  MEDICAL    JURISPRUDENCE. 

not,  she  says,  give  any  explanation  of  their  appearance.  Dur- 
ing her  stay  in  the  hospital  in  February  last,  ten  needles  and 
pins  were  removed  by  Mr.  Baker  and  Mr.  Ferguson. 

The  facts  that  the  right  hand  and  arm  presented  two  marks 
only  where  needles  had  been  withdrawn,  whereas  the  left -hand 
and  arm  showed  thirty-seven  marks,  that  the  girl  was  righi- 
handed,  that  all  the  pins  were  destitute  of  heads,  together 
Avith  other  circumstances,  led  to  the  conchision. 

Pretended  Assaults. — The  most  striking  changes  of  char- 
acter are  evinced  by  young  girls  whose  disordered  emotions 
lead  them  to  behave  in  a  manner  to  impress  all  who  see  them 
that  they  are  possessed  with  a  devil.  Says  Wilks,*  "  When 
you  see  a  paragraph  headed,  '  extraordinary  occurrence,'  and 
you  read  how  every  night  loud  rapping  is  heard  in  some  part 
of  the  house,  or  how  the  rooms  are  being  constantly  set  on 
fire,  or  how  all  the  sheets  in  the  house  are  devoured  by  rats, 
you  may  be  quite  sure  that  there  is  a  young  girl  on  the  premises." 

During  the  excitement,  which  is  often  epidemic,  we  are  oc- 
casionally startled  by  the  recital  of  sensational  stories  with 
which  the  press  teems.  Only  within  the  past  month  two  cases 
of  probable  hysterical  troubles  of  this  kind  have  obtained 
wide  publicity.  One  of  these  is  that  of  a  young  girl  in  Rich- 
mond, who  claimed  she  was  assaulted  by  burglars,  but  her 
story  was  palpably  false,  and  her  state  of  mind  grew  out  of  the 
general  feeling  of  alarm  that  attends  the  commission  of  sev- 
eral real  burglarious  attempts  in  the  neighborhood. 

A  nurse  girl  some  months  ago  declared  that  the  child  com- 
mitted to  her  care  had  been  stolen  from  her  by  men  in  the 
street,  and  great  consternation  was  caused  by  her  story,  that 
she  related  on  her  return.  The  friends  of  the  girl,  however,  a 
few  hours  afterwards,  restored  the  child  to  its  parents,  and  it 
transpired  that  the  woman  had  purposely  left  it  with  them. 

Cases  are  detailed  where  women  have  set  fire  to  buildings, 
or  the  clothing  of  children,  and  were  unable  to  give  any  motive 
for  the  crime.  There  is  another  class  of  cases  the  subjects  of 
which  claim  they  have  been  outraged  or  maltreated,  and  give 
the  impression  that  self-inflicted  wounds  were  made  by  their 
assailants,  and  as  a  result  innocent  jjersons  are  occasionally 
arrested.  In  such  cases  local  examination  will  rarely  reveal 
any  indication  of  violence,  but  in  cases  of  women  of  question- 
able purity  it  is  a  difficult  matter  to  swear  positively  from  any  • 
examinatif)n  that  their  stories  are  not  true. 

*  Lectures  upon  Diseases  of  the  Nervous  System,  p.  367. 


HYSTEROIU    STATES    AND    FEIGNED    DISEASES.  189 

Medical  men  are  occasionally  troubled  by  women  who  claim 
that,  thev  have  been  maltreated  or  outraged.  Such  persons  are 
apt  to  trump  up  cases  in  Court  and  are  ready  litigants.  The 
charges  against  respectable  persons  rarely  stand  the  test  of  care- 
ful examination,  and  it  will  always  be  found  that  the  stories 
told  are  overdrawn  and  bear  the  manifest  evidences  of  fraud 
and  exaggeration.  A  prominent  practitioner  of  New  York  was 
sued  some  years  ago  by  an  adventuress  who  claimed  that  she 
had  been  poisoned  by  nux  vomica.  The  evidence  showed  that 
her  pretended  poisonmg  was  of  hysterical  origin,  and  that  she 
had  repeatedly  made  requests  for  money,  threatening  various 
things  should  the  doctor  fail  to  accede  to  her  demands. 

A  case  where  a  young  woman  had  claimed  that  she  had  been 
outraged  is  detailed  by  Ross  :* 

"In  December,  1876,  a  girl  of  eighteen  was  found  one  eve- 
ning standing  with  her  clothing  wet  and  muddy,  in  an  appa- 
rently stupefied  condition,  in  the  closed  doorway  of  a  restaurant 
in  the  center  of  Manchester,  a  few  yards  from  where  she  was 
lodging.  She  was  taken  home  and  to  bed,  and  a  medical  man 
was  sent  for.  He  found  her  to  all  appearance  unconscious  of 
what  was  going  on  around  her,  and  uttering  some  disjointed 
and  incoherent  complaints  of  having  been  drugged  and  threat- 
ened. He  thought  she  was  recovering  from  the  effects  of  some 
narcotic  and  did  not  at  first  pay  much  attention  to  her  story. 
The  following  day,  however,  she  appeared  worse,  and  in  the 
evening  her  condition  was  considered  so  critical  that  the  police 
were  communicated  with,  with  a  view  to  her  statements  be- 
ing taken  down.  She  was  visited  by  two  experienced  detect- 
ives, who,  seeing  how  matters  stood,  and  having  the  doctor's  as- 
surance that  she  was  in  a  dying  state,  sent  at  once  for  a  magis- 
trate, before  whom  she  made  a  solemn  declaration  to  the  fol- 
lowing effect :  She  believed  herself  to  be  dying.  On  the  pre- 
vious evening  a  solicitor,  at  whose  office  she  had  called  on  busi- 
ness, told  her  she  must  go  into  a  convent,  and  gave  her  '  some 
sort  of  a  dark,  sweet  drink'  which  rendered  her  senseless.  On 
going  down-stairs  from  the  office  slie  met  a  Jesuit  father,  whom 
she  had  seen  once  before.  This  gentleman  took  hold  of  her 
and  pulled  her  along  the  street  to  a  little  house  in  a  court,  where 
there  was  an  upper  room  with  a  bed  in  it  and  a  cross  on  the 
wall.  Having  got  her  in  the  room,  he  said  improper  things  to 
her,  and  gave  her  a  little  cake  which  affected  her  directly.  The 
woman  of  the  house   came  into  the  room  and  found  her  on  the 

*  Vol.  ii,  p.  8S7. 


19°  MEDICAL    JURISPRUDENCE. 

floor,  after  which  she  somehow  got  outside,  the  priest  following. 
He  again  dragged  her  along  in  the  dirt  to  the  street  corner 
where  he  ran  away. 

"  The  solicitor  and  the  priest,  both  of  them  well  known  and 
highly  respected,  were  thereupon  placed  under  arrest  in  the  mid- 
dle of  the  night  on  a  charge  of  having  administered  certain 
poisonous  drugs  with  intent  to  murder.  The  story  was  proved 
to  be  purely  imaginary,  and  the  magistrates  dismissed  the  case." 

Du  SauUe  relates  the  case  of  a  young  girl,  who  under  the  in- 
fluence of  hysteria  made  the  most  calumnious  accusations 
against  the  priests  and  against  the  members  of  a  religious  order, 
whom  she  claimed  to  have  outraged  her.  The  father  of  the 
girl  killed  himself  in  despair,  and  it  afterwards  transpired  that 
she  was  declared  a  virgin  by  the  Faculty  of  Medicine  of  Mont- 
pelier. 

Chloroform  and  Hysteria. — Our  services  are  sometimes 
required  in  cases  where  it  is  claimed  that  cliloroform  has  been 
used  in  the  perpetration  of  crime,  either  for  the  purpose  ot 
facilitating  robbery,  or  more  rarely  in  cases  where  hysterical 
women  have  made  the  claim  that  they  have  been  outraged  under 
its  influence.  This  is  the  case  where  nymphomania  or  eroto- 
mania has  existed,  but  very  often  the  claims  of  such  people  will 
not  bear  investigation.  Mcintosh  in  an  article  upon  morbid 
impulse  refers  to  a  woman  who  was  the  subject  cf  excessive 
nervous  exhaustion,  who '*  is  never  done  talking  of  honorable 
marriage  and  the  husband  she  ought  to  have  had,  if  she  had 
been  permitted  to  remain  outside  the  asylum,  away  from  the 
parties  that  administered  chloroform  and  ether  to  her.  In  her 
case  there  is  hyperesthesia  of  the  emotions,  and  her  impas- 
sioned entreaties,  tears  and  seizing  of  the  hand  betray  the  ardor 
of  her  attachment."  The  element  of  mystery  and  the  popular 
superstition  regarding  the  use  of  anesthetics  often  lead  to  their 
being  referred  to  by  women  who  claim  that  they  are  the  sub- 
jects of  indecent  assault.  The  papers  were  filled  some  years  ago 
with  the  remarkable  declarations  of  a  young  woman,  who  lived 
in  an  interior  town  in  New  York,  and  who  claimed  that  v/hilc 
alone  in  the  house  she  was  surprised  by  the  entrance  of  masked 
robbers,  who  bound  and  gagged  her,  and  appHcd  chloroform 
upon  a  cloth  to  her  face,  and  after  assaulting  her  brutally  she  be- 
came unconscious.  The  story  was  so  palpably  fraudulent  that 
it  should  have  received  little  or  no  recognition  by  those  about 
her;  but  as  in  other  cases  of  the  kind  we  find  sympathetic 
friends,  and  a  sensational  press  ever  ready  to  believe  in  and 


HYSTEROID    STATES    A~ND    FEIGNED    DISEASES.  19I 

give  publicity  to  the  hysterical  plaint  of  the  impostor.  In  this 
case  the  ropes  that  bound  her  were  evidently  applied  by  herself, 
and  the  quantity  of  chloroform  alleged  to  have  been  used,  a 
small  bottle  having  been  found,  (which  it  transpired  'she  had 
bought  herself),  made  her  story  appear  at  once  manifestly 
absurd. 

Pretended  Assaults  hy  Dentists. — We  from  time  to  time 

hear  of  cases  in  which  women  claim  that  while  in  the  dentist's 
chair  and  under  the  influence  of  chloroform  they  have  been  in- 
decently assaulted  by  the  operator.  Unfortunately  for  the  den- 
tist he  has  no  witnesses  to  prove  his  innocence,  and  the  unsup- 
ported statement  of  the  patient  who  is  hysterical  and  labors 
under  an  hallucination  is  often  received  by  sympathetic  jurors  as 
true  ;  for  it  cannot  be  conceived  by  them  how  any  woman  could 
so  forget  herself  as  to  make  a  charge  of  this  kind,  unless  there  was 
some  actual  ground.  Wharton  and  Stille*  report  the  case  of  an 
eminent  and  highly  respectable  dentist  who  was  charged  with 
rape  upon  a  young  lady  of  unimpeachable  character,  who  was 
engaged  to  be  married.  She  testified  that  the  doctor,  who  had 
been  her  dentist  for  a  number  of  years  had  previously  always 
behaved  toward  her  like  a  gentleman.  On  this  occasion  the 
tooth  on  which  he  was  operating  gave  her  much  pain  and  the 
dentist  offered  to  put  something  in  it  to  destroy  the  nerve  or 
give  her  ether  as  she  wished.  She  told  him  she  preferred  the 
ether,  which  was  administered.  She  became  somewhat  under 
the  influence  of  it,  but  stated  she  did  not  lose  consciousness, 
but  was  unable  to  move.  The  dentist  then  felt  her  pulse  and 
passed  his  hand  up  her  arm  under  her  loose  sleeve,  and  after  this 
put  his  hand  on  lier  breast  under  her  dress  ;  he  then  put  it  up 
under  her  dress,  then  went  before  her,  raises  her  clothes,  sepa- 
rated her  feet,  which  were  crossed,  and  drew  her  to  the  edge  of 
the  chair  and  had  intercourse  with  her  in  that  position  ;  during 
all  this  time  her  eyes  were  closed.  All  of  the  above  she  testified 
she  could  distinctly  remember.  The  dentist  then  went  to  the 
washstand,  poured  water  into  the  basin,  returned  and  put  her 
clothes  down  and  lifted  her  back  in  the  chair.  After  a  few 
minutes  he  told  her  that  he  would  have  to  take  one  of  her  teeth 
out,  which  he  did  after  giving  her  ether  at  her  request.  After 
her  return  to  consciousness  she  was  introduced  to  another  pa- 
tient who  had  come  in.  Then  after  making  an  appointment  for 
another  day  with  the  dentist  to  have  the  teeth  finished,  bade 
the  dentist  good-by   and   made  no   complaint    until  she    had 

*  Wharton  and  Stifle  Med.  Jurisprudence,  vol.  ii,  p.  245. 


192  MEDICAL   JURISPRUDENCE. 

reachea  home.  In  the  evening  she  began  to  menstruate,  and 
before  this  she  did  not  examine  herself  or  her  clothing;  nor  was 
this  done  by  any  one.  Two  or  three  days  later  her  clothes  were 
examined  by  her  mother  and  then  washed. 

The  dentist  was  found  guilty  and  sentenced  to  four  years 
and  six  months'  imprisonment  ;  he  was  however  subsequently 
pardoned  by  the  executive  of  the  State,  in  consequence  of  the 
large  mass  of  testimony;  presented  by  physicians  and  dentists 
going  to  prove  the  entire  possibility  that  the  whole  accusa- 
tion grew  out  of  an  hallucination  such  as  ether  is  able  to 
produce. 

A  case  closely  resembling  that  of  Dr.  B.>  occurred  at 
Montreal  in  1858.  A  demist  was  indicted  for  attempting  to 
commi^  a  rape  upon  one  of  his  patients  under  the  influence 
of  chloroform.  At  the  trial  a  witness  testified  that  his  wife  was 
under  the  strongest  impression  that  she  had  been  violated  by 
the  prisoner  while  under  the  influence  of  chloroform  :  yet  her 
husband  was  present  during  the  whole  time  she  was  uncon- 
scious. The  verdict  of  the  jury  was,  '*  guilty  of  an  attempt  to 
commit  a  rape,  with  a  recommendation  to  mercy  ."  {Bosto?i 
Med.  &=  Surgical  Jour7i.^  November,  1858,  p.  287,  and  Wharton 
&  Stille,  vol.  ii,  p.  248.) 

How  much  more  just  was  the  decision  of  the  jury  in  the  fol- 
lowing case  : — 

"  In  the  Midland*  Circuit,  Northampton,  Eng.,  a  sur- 
geon's assistant,  Mr.  George  Howard,  aged  32,  was  indicted  for 
having  on  September  11,  feloniously  and  violently  assaulted 
and  outraged  Fanny  Harriot  Childs.  It  seems  that  the  prisoner 
had  on  tlie  day  before  administered  chloroform  in  his  surgery 
but  did  not  succeed  in  producing  unconsciousness.  She  called 
the  next  day,  and  he  then  said  he  had  some  stronger  chloro- 
form, and  again  attempted  to  produce  anesthesia.  For  a 
whole  hour  she  remained  conscious,  at  the  end  of  that  time 
Miss  Fellows,  the  only  other  person  in  the  room,  went  out. 
On  her  departure,  the  plaintiff  testifies  that  the  prisonf.r  got 
down  upon  his  knees  and  committed  the  offense  with  which  he 
was  charged.  While  this  was  going  on  she  was  perfectly  con- 
scious but  powerless.  Miss  Fellows  returned  in  about  fifteen 
minutes,  and  found  the  plaintiff  sitting  in  the  chair  in  precisely 
the  same  position  in  which  slie  was  left.  She  was  then  speech 
less.  Soon  after  this  the  plaintiff  was  escorted  home  by  Miss 
Fellows  and  the  prisoner,  she  walking  between  them.     She  was 

*Bntish  Med  yournal^  Nov.  17,  1877,  page  709 


HYSTEROID    STATES   AND    FEIGNED    DISEASES.  I93 

unable  to  speak  until  she  arrived  at  her  home,  and  not  till  after 
the  prisoner  left.  She  whispered  to  her  husband  something 
about  his  being  a  scamp,  and  later  she  made  the  complaint 
about  him  to  several. 

"  Dr.  Benjamin  Richardson,  F.  R.  S.,  of  London,  who  was 
called  for  the  defense,  said  that  chloroform,  laughing  gas,  etc., 
had  been  his  special  study.  There  were  four  stages  or  degrees 
in  which  chloroform  operated.  The  first  stage  being  one  in 
which  consciousness  was  not  actually  lost  ;  there  was  little  re- 
sistance, and  a  desire  for  air.  The  second  one  was  a  stage  in 
which  consciousness  was  lost,  but  operation  was  impossible  ; 
the  patient  often  screamed  often  without  provocation.  The  third 
stage  was  that  of  complete  unconsciousness.  There  was  no 
rigidity ;  if  the  eye-ball  were  touched,  the  eye  would  not 
flinch,  and  in  that  stage  the  administrator  would  say  to  the 
surgeon  :  *  You  may  go  on.'  That  was  the  last  stage  for 
operation  in  a  large  number  of  cases.  Judging  by  the  descrip- 
tion given  by  the  prosecutrix  of  her  own  condition  on  the  day 
of  the  alleged  assault,  he  believed  she  was  in  the  second  stage. 
In  his  own  experience,  he  had  known  persons  in  the  second 
stage  subject  to  delusions  as  to  what  had  taken  place  while 
under  the  influence  of  chloroform.  Dr.  Richardson  gave  a 
number  of  instances  which  had  come  under  his  observation  ; 
and  stated  that  those  delusions  were  the  subject  of  some  of  the 
earliest  objections  to  chloroform.  He  mentioned  the  case  of 
a  lady  who,  in  the  presence  of  himself,  her  father  and  her 
mother,  and  a  dentist's  assistant,  while  under  the  influence  of 
chloroform,  brought  a  charge  against  the  dentist  who  was  ope- 
rating upon  her  precisely  similar  to  the  one  in  the  present  case, 
and  continued  firm  in  the  belief  that  the  charge  was  well 
founded,  long  after  the  influence  of  the  chloroform  had  passed 
off,  and  probably  still  continued  in  the  belief. 

"  Other  medical  witnesses  gave  similar  testimony  regarding  the 
delusions  of  incomplete  anesthetization.  The  jury  gave  a  ver- 
dict of  acquittal.  The  justice  then  remarked  that  this  was  no 
imputation  on  the  veracity  of  the  prosecutrix,  who  was  un- 
doubtedly under  a  delusion  ;  and  also  that  prisoner  was  en- 
tirely cleared  of  any  imputation  in  respect  to  the  charge.  The 
prisoner  was  then  discharged." 

Every  physician  familiar  with  the  use  of  anesthetics,  espec- 
ially chloroform,  knows  that  at  a  stage  of  the  anesthesia  the 
patient  is  very  apt  to  have  erotic  excitement,  which  may  amount 
to  actual  hallucinations,  and  in  these  cases  the  patient  may  be 
perfectly  honest  in  her  belief  that  she  has  been  outraged.     Hap- 


194  MEDICAL    JURISPRUDENCE. 

pily,  since  the  introduction  of  nitrous  oxide  gas  in  dentistry, 
the  effects  upon  the  nervous  system  are  more  transient,  and  we 
do  not  hear  of  so  many  accusations  brought  by  hysterical  or 
designing  females.  The  medical  examination  of  such  cases 
tends  to  relieve  any  objective  signs  of  the  alleged  assault, 
whether  it  has  occurred  or  not,  and  no  reliance  can  be  placed 
upon  the  majority  of  the  ordinary  tests  laid  down  by  the  text- 
books. 

We  are  to  carefully  investigate  the  patient's  history  in  all 
such  cases,  her  disposition,  and  anything  that  may  lead  us  to 
suppose  she  is  the  subject  of  hysteria. 

Can  Persons  he  Robbed  While  Under  the  Influence 
of  Chloroform  ? — In  cases  where  it  is  alleged  that  chloroform 
has  been  used  to  facilitate  robbery,  we  may  ^afely  doubt  the 
statements  of  the  victim.  It  has  been  held  by  numerous 
authors,  that  it  is  utterly  impossible  for  a  person  while  asleep 
to  be  anesthetized  without  some  resistance.  The  late  Dr. 
Stephen  Rogers,  some  years  ago,  in  an  excellent  article,  ex- 
pressed himself  as  follows  : 

1.  "  As  to  its  use  to  promote  the  greater  security  from  the  dis- 
turbance of  the  sleeper,  even  were  that  practicable,  the  very 
time  tliat  would  be  consumed  in  the  gradual  and  cautious  ad- 
ministration of  the  vapor, — the  only  possible  and  theoretical 
manner  of  accomplishing  it — would  so  increase  the  danger  of 
detection,  that  few  thieves  would  think  of  employing  it. 

2.  "  During  the  course  of  the  administration  of  chloroform, 
whatever  manner  may  be  adopted,  the  patient  or  subject  as  a 
rule  becomes  excited,  often  very  violent  and  turbulent,  with  an 
irrepressible  propensity  to  sing  and  shout,  which  is  often  so 
loud  as  to  alarm  the  inmates  of  the  whole  house.  He  is  in  a 
state  of  wild,  chloroformic  intoxication.  The  exceptions  to 
this  rule  are  so  few,  that  no  prudent  thief  would  think  of  run- 
ning the  risk  of  meeting  one  of  these  exceptions. 

3.  "  Supposing  the  two  preceding  obstacles  overcome,  and  the 
victim  thoroughly  quieted  into  a  narcotic  sleep,  a  third  and 
very  frequent  complication  arises.  He  begins  to  vomit,  and 
while  he  generally  does  not  make  much  noise  about  it,  still  he 
may,  and  he  always  requires  attention,  lest  fatal  strangulation 
occur.  It  may  be  presuming  too  much  to  credit  this  class  of 
criminals  with  any  care,  whether  their  supposed  chloroformed 
victims  die  of  strangulation  or  not,  but  I  think  that  a  common- 
sense  view  of  the  case  must  lead  to  the  conclusion  that  even 
were  chloroform  an  available  agent  in  facilitating  robbery,  the 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  I95 

knowledge  among  the  criminal  classes  that  the  abandonment  of 
their  victim  with  a  towel  still  over  his  face,  and  the  liabilities 
of  vomiting  and  strangulation  would  often  add  the  crime  of 
murder  to  that  of  robbery,  would  have  great  effect  in  deterring 
them  from  the  further  employment  of  it." 

Taylor,  in  his  work  upon  poisons,  refers  to  this  subject,  and  dis- 
believes the  stories  of  persons  who  claim  to  have  been  suddenly 
rendered  insensible  for  the  purposes  of  robbery  or  rape.  The 
strongest  argument  against  forcible  and  sudden  anesthesia 
has  been  presented  by  Stevenson,  of  Guy's  Hospital,  who  found 
that  in  more  than  two  hundred  cases  where  chloroform  had 
been  administered  to  adults  they  were  not  rendered  insensible 
until  eight  or  ten  minutes,  and.  has  alluded  to  the  fact  well 
known  to  medical  men  who  have  occasion  to  use  chloroform, 
that  many  individuals  are  able  to  stand  immense  quantities 
without  any  appreciable  effect. 

Ur.  R.  M.  Denig,  in  a  paper  on  chloroform  and  its  medico- 
legal relations,  read  before  the  Columbus  Pathological  Society, 
reported  in  the  Ohio  Medical  Recorder,  January  1877,  gives 
the  results  of  a  number  (some  29)  experiments  on  different 
persons  to  learn  if  chloroform  could  be  administered  to  anes- 
thesia, to  persons  asleep  without  waking  them.  A  certain 
number  of  cases  (about  one-third)  he  succeeded  in  anesthetiz- 
ing without  waking  them,  but  in  order  to  accomplish  this  he 
found  great  caution  and  great  skill  were  necessary,  and  con- 
cludes "  that  the  expert  ought  in  justice  to  declare  that  it  is 
possible,  if  it  is /zi?/ easy,  to  render  a  person  insensible  by  chlor- 
oform during  a  natural  sleep,  in  order  that  he  may  be  made 
the  victim  of  a  criminal  assault." 

Cases  are  adduced  which  show  that  the  motives  of  the 
alleged  victims  are  of  the  most  questionable  sort,  and  that  not 
only  is  the  claim  of  compulsory  anesthesia  made  to  cloak  some 
crime,  but  it  is  advanced,  as  I  have  said,  by  young  women  of 
an  hysterical  turn  of  mind,  or  men  of  a  similar  temperament,  as 
a  means  of  creating  sympathy. 

If  among  this  latter  class  there  is  a  strong  temptation  to 
pose  as  heroes  or  heroines,  or  for  the  sake  of  newspaper  no- 
toriety. 

A  most  remarkable  case  where  the  victims  of  a  robbery 
honestly  believed  they  had  been  chloroformed,  is  the  follow- 
ing :  In  August,  187 1,  a  house  in  Seventy-first  street  was 
entered  by  burglars,  who  broke  a  pane  of  glass  of  a  rear  base- 
ment window,  pushed  back  the  bolt  and  raised  the  sash.  They 
took  from  the  dining-room  a  quantity  of  silver-plate,  and  enter- 


196  MEDICAL   JURISPRUDENCE. 

ing  the  sleeping-room  of  the  proprietor,  rifled  his  pockets  of 
over  one  hundred  dollars,  and  made  off  with  his  studs,  sleeve 
buttons,  as  well  as  some  expensive  wearing  apparel  of  the  ladies 
of  the  family.  They  next  entered  the  room  occupied  by  two 
young  ladies,  and  collected  a  quantity  of  jewelry  and  money, 
and  left  the  house.  It  was  claimed  that  all  the  members  of  the 
household  had  been  drugged  with  chloroform,  and  they  did  not 
awaken  until  late  the  next  morning,  and  then  they  suffered 
severely  from  the  after  effects  of  the  drug.  The  story  of  the 
chloroform  poisoning  seems  to  have  arisen  in  the  mind  of  one 
of  tlie  young  ladies,  who  was  of  a  highly  nervous  temperament 
and  suffered  from  extreme  emotional  excitement,  incident  to 
the  adventures  of  the  night.  She  alleged  that  chloroform  had 
been  used,  and  she  based  her  opinion  upon  the  presence  of  fine 
powder  or  dust,  which  was  scattered  upon  the  articles  about  the 
room.  As  chloroform  leaves  no  such  deposit,  the  conclusion  is 
irresistible  that  the  drug  had  not  been  used. 

Many  of  the  imaginative  tendencies  of  young  women  of  this 
class  arise  from  the  exceeding  sensational  newspaper  paragraphs 
and  flashy  novels  which  they  have  read.  An  absurd  instance 
occurred  in  California,  where  a  man  was  actually  tried  for  rape, 
and  sentenced  to  imprisonment  for  several  years,  upon  the 
story  of  a  waiter  girl  who  slept  in  the  same  hotel.  It  appeared 
from  her  statement,  that  the  defendant  learning  that  chloroform 
might  be  introduced  into  the  room  by  means  of  a  key-hole, 
procured  a  spray  apparatus,  with  which  he  deluged  the  room 
with  the  vapor  of  this  anestlietic,  producing  insensibility  of  his 
victim,  and  afterwards  entering  and  committing  the  crime. 
It  appeared  in  evidence  that  an  empty  bottle  labeled  chloro- 
form was  found  in  his  room,  and  this  left  no  doubt  in  the  minds 
of  the  jury  as  to  his  guilt.  Dr.  Rogers,  in  referring  to  the  case, 
says  :  "  The  totally  absurd  character  of  the  allegation  is  ap- 
parent to  every  one  instructed  and  experienced  in  the  use  and 
in  the  effects  of  chloroform.  We  will  suppose,  by  the  way  of 
illustration,  that  the  occupant  of  such  a  room  as  this  girl  is  said 
to  have  slept  in  may  be  anesthetized  unconsciously  by  the  vapor 
of  chloroform  tlius  introduced  througli  the  key-hole,  though  I 
regard  it  impossible.  But  how  is  the  operator,  especially  if  he 
bean  ignorant  hotel  waiter,  without  the  slightest  knowledge  of 
chloroform,  to  know  when  unconsciousness  is  effected?  How 
is  he  to  tell  when  the  victim  is  ready  for  the  breaking  open  of 
the  door  ?  Would  the  most  skilled  administrator  of  chloroform 
venture  to  fix  the  moment  that  the  occupant  of  any  given  room 
w<)uld  be  anesthetized  by  chloroform  thus  introduced  into  it? 


HYbTKKOIU    STATES    AND    FEIGNED    DISEASES.  I97 

Would  he  dare  to  indicate  the  time  which  divides  the  period  of 
unconsciousness  to  all  outer  impressions  and  violence,  or 
perfect  anesthesia,  from  that  of  fatal  poisoning  from  chloro- 
form ?  Could  he  tell  the  moment  that  it  sliould  be  discon- 
tinued in  order  to  avoid  this  fatal  consequence  ?  I  apprehend 
that  such  as  could  would  be  difficult  to  find. 

"  It  is  therefore  obvious,  that  if  this  hotel  servant  committed  the 
crime  alleged  under  circumstances  sworn  to,  it  must  have  been 
brought  about  by  most  extraordinary  combination  of  accidents, 
leaving  out  the  question  how  he  himself  breathed,  consumma- 
ted his  crime,  in  the  same  atmosphere,  or  rather  chloroform 
vapor,  which  rendered  his  victim  insensible  and  kept  her  insen- 
sible for  an  indefinite  time." 

Dr.  W.  H.  Devitt*  is,  however,  of  the  opinion  that  anesthesia 
may  be  produced  by  means  of  chloroform  introduced  into 
sleeping  apartments,  and  he  relates  the  extraordinary  instance 
of  a  family  of  seven  persons  who  were,  in  his  opinion,  at 
least,  so  much  under  the  influence  of  chloroform,  introduced 
into  the  room  by  means  of  balls  of  cotton  saturated  with  it, 
that  they  slept  while  the  house  was  being  entered  by  burglars, 
who  ransacked  the  house,  and  who  even  had  the  audacity  to 
take  a  lunch  from  the  pantry. 

We  are  sometimes  called  to  see  patients  in  an  apparently  un- 
conscious state,  the  assumption  being  that  they  are  under  the 
influence  of  chloroform.  While  we  take  into  account  that  the 
anesthetic  state  lasts  but  a  comparatively  short  time  after  the 
use  of  the  agent  has  been  discontinued,  we  are  to  appreciate 
the  fact  that  a  certain  amount  of  muscular  rigidity  exists 
instead  of  the  limpness  and  relaxation  of  chloroform  narcosis, 
and  it  will  be  found  upon  touching  the  eye-ball  that  attempts 
are  made  to  close  the  eye,  and  to  resent  this  interference,  if  the 
patient  be  shamming,  there  will  be  an  absence  of  the  pulse 
changes,  and  the  patient  will  often  be  detected  in  casting 
furtive  glances  about  the  room,  when  she  thinks  she  is  unob- 
served. In  addition  there  will  be  found  an  ostentatious  display 
of  bottles,  and  if  injuries  are  referred  to,  the  marks  will  be  of 
the  most  insignificant  kind,  and  probably  produced  by  the 
patient  herself. 

Hysteria  in  Men. — As  hysteria  occurs  in  males  as  well  as 
females  the  question  may  arise  sometimes  whether  the  symptoms 
of  so-called  cases  of  insanity  are  not  those  of  hysterical  trouble 

*  Am.  Joural  of  Medical  Science,  July,  1875,  p  145. 


iq8  medical  jurisprudence. 

I 

after  all.  Wilks  refers  to  the  case  of  a  man  who  had  lost  a 
great  deal  of  money  in  speculation,  and  who  for  a  short  time 
became  utterly  unreasonable,  but  recognized  his  foolish  indul- 
gence in  emotional  excitement  and  his  behavior,  but  could 
not  control  himself,  and  indulged  in  involuntary  laughter  and 
crying. 

Charcot,*  in  an  interesting  clinical  lecture,  speaks  of  male 
hysteria  which  he  is  not  disposed  to  think  a  very  rare  af- 
fection. 

"  It  will  not  be  out  of  place  to  say  a  few  words  concerning 
the  hysterical  neurosis  so  far  as  it  is  shown  in  the  masculine 
sex.  Hysteria  is,  incontestably,  more  frequently  found  in  the 
male  than  is  generally  supposed.  This  subject  of  male  hyste- 
ria is  one  of  those  to  which,  of  late  years,  doctors  have  given 
much  attention.  No  less  than  five  inaugural  dissertations  re- 
lating to  the  matter  were  presented  to  the  Paris  Faculty  from 
1875  to  1880.  Already  Briquet  in  his  excellent  book  had 
stated  that  for  every  20  hysterical  women — in  Paris  at  least — 
there  was  one  man  attacked  by  the  same  affection.  This  figure 
appeared  to  me  large.  Nevertheless  M.  Klein  was  able  to 
bring  together  from  these  authors  77  cases  of  hysteria  in  the 
male,  to  which  he  added  3  cases  within  his  own  knowledge  ; 
whence  it  was  necessary  to  conclude  that  hysteria  in  the  male 
is  really  not  a  rare  affection. 

"A  fact  brought  to  light  in  the  same  work,  is  that  when  de- 
veloped in  man,  hysteria  is  generally  hereditary.  This  is  found 
to  be  the  case  in  27  out  of  30  cases,  and  it  is  this  matter  of  ma- 
ternal heredity  and  of  similar  heredity  {Jie'r^ite  similaire) 
which  leads  to  the  saying  that  hysteria  in  the  mother  often  en- 
genders hysteria  in  the  son." 

When  the  disease  is  presented  by  men  the  subjects  are  usual- 
ly well  developed  and  apparently  healthy  persons.  In  such 
cases  as  this  we  are  often  called  to  decide  the  cpiestion  whether 
the  troubles  of  the  patient  are  or  arc  not  of  grave  origin. 

I  was  called  some  years  ago  to  see  a  man  whom  I  found  to  be 
in  a  state  of  opistliotonus  and  it  was  at  first  supposed  he  had 
taken  strychnine.  I  found  that  there  were  none  of  the  clonic 
convulsions  of  strychnia  poisoning,  and  after  waiting  a  few  min- 
utes all  fears  of  such  a  condition  of  affairs  were  dispelled  by 
his  evident  hysteria,  and  his  speedy  recovery  when  the  use  of 
the  actual  cautery  was  suggested. 


*  Le  Progrds  Medicate,  Jan.  20;  Feb.  7,  1883;    N.  Y.  Med.  Abst.,  March, 
1883. 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  I99 

Hysteria  in  its  Relations  to  Organic  Disease. — Hys- 
teria often  exists  as  a  symptom  of  organic  disease  of  the  nerv- 
ous centers  and  we  may  do  an  alleged  imposter  injustice.  As 
a  rule  such  hysteria  is  associated  with  hemiplegia  or  equally 
well  marked  conditions. 

Responsibility  of  the  Hysterical  Subject.— The  deter- 
mination of  the  responsibility  of  hysterical  individuals  is  far 
from  easy.  Du  SauUe  says:  "  Can  we  apply  to  the  passions 
the  same  rules  as  we  can  to  madness  ?  Evidently  not.  Vio- 
lent passions  influence  the  judgment,  and  even  throw  a  false 
coloring  over  it  in  a  grievous  manner,  but  they  cannot  annihi- 
late it;  they  occasionally  carry  away  the  mind  to  form  extrava- 
gant resolutions,  but  on  the  brain  no  pathological  trace  can  be 
detected.  I  will  grant  that  in  the  instances  we  are  discussing  they 
might  override  the  will,  but  moral  responsibility  is  only  lessened 
but  not  removed." 

In  his  great  treatise  upon  medical  jurisprudence  he  arrives 
at  the  following  conclusions,  which,  from  a  medico-legal  point 
of  view,  are  the  following:  ''  i.  Hysteria  as  it  is  generally  un- 
derstood is  not  a  disease  in  any  way  caused  by  continence;  2. 
in  hysteria  the  affective  faculties  are  disordered  in  different  de- 
grees, but  the  intelligence  remains  intact  in  the  great  majority 
of  cases;  3.  a  feeble  state  of  the  will  exists  in  hysteria  and  does 
not  compromise  the  moral  liberty  so  far  as  the  loss  of  con- 
sciousness of  the  acts  is  concerned  ;  4.  hysteria  of  a  high  degree 
brings  with  it  a  diminution  of  responsibility;  5.  the  mental  de- 
rangement known  as  hysterical  insanity  is  a  true  disease,  and 
often  dangerous  ;  it  is  sometimes  incurable,  and  necessarily 
brings  with  it  immunity  from  punishment." 

Punishability  of  the  Insane. — The  punishability  of 
hysterical  patients  cannot  be  positively  fixed.  In  the  epidem- 
ical form  of  the  disease  wholesale  punishment  is  the  surest  meth- 
od of  arrest,  and  in  individual  instances  the  same  rule  holds 
good.  The  hysterical  girl  who  commits  a  wanton  crime  should 
be  the  subject  of  punishment  just  as  the  vicious  imbecile.  The 
knowledge  of  right  and  wrong  exists — probably  to  a  more 
marked  degree  in  these  cases  than  in  any  other,  and  the  woman 
often  calculates  just  how  much  mischief  she  may  inflict  upon  oth- 
ers. As  to  loss  of  voluntary  control,  that  is  a  different  matter. 
When  the  hysteria  is  associated  with  marked  intellectual  and 
moral  perversion,  with  delusions  and  hallucinations,  we  must 
approach  the  ground  of  responsibility  with  some  caution.  (See 
Appendix  H.) 


MEDICAL    JURISPRUDENCE. 


FEIGNED    DISEASES. 


The  subject  of  feigned  diseases  is  one  of  decided  importance 
to  medical  officers,  who  are  brought  in  contact  with  soldiers 
and  sailors  and  prisoners  ever  ready  to  shirk  their  work,  or 
to  secure  comfortable  quarters  in  a  hospital,  or  to  furnish  a 
pretext  for  discharge  from  duty;  and  we  find  as  well,  as 
I  will  show  in  considering  cranial  and  sj^inal  injuries,  that 
diseases  are  oftea  feigned  for  the  purpose  of  securing 
compensation  in  court  for  trivial  injuries.  Ogston,  whose 
classical  work  is  one  of  the  best  of  modern  times,  speaks  of 
feigned  Sind  factitious  diseases.  According  to  his  classification, 
we  may  consider,  "  (i),  feigned  diseases  strictly  so-called,  or 
those  which  are  altogether  fictitious;  and  (2),  factitious,  or 
those  which  are  wholly  produced  by  the  patient,  or  at  least  at 
his  convenience.  To  these  have  been  added  by  some  writers, 
(3),  exaggerated  disease,  or  those  which  existing  in  some  degree 
or  form  are  pretended  by  the  party  to  exist  in  a  greater  degree 
or  different  form;  and,  (4),  aggravated  diseases,  or  those  which 
originating  in  the  first  instance  without  the  person's  concurrence 
are  intentionally  increased  by  artificial  means."  As  Ogston  sug- 
gests, this  is  a  delicacy  in  distinction  which  is  hardly  warranted, 
for  a  purely  factitious  disease  maybe  exaggerated  or  aggravated 
in  a  particular  instance,  wliile  a  person  who  simulates  disease 
may  at  the  same  time  present  features  of  a  factitious  disease. 

The  ingenuity  of  malingerers  is  almost  incredible.  Not  only 
may  they  resort,  when  occasion  requires,  to  all  manner  of  dis- 
gusting performances,  such  as  swallowing  excrement  or  blood 
or  other  offensive  substances  to  carry  out  the  particular  role 
they  wish  to  play,  but  they  may  also  actually  maim  or  injure 
certain  organs  for  the  purpose  of  gaining  their  object.  The 
greatest  difficulty  in  detecting  impostures  arises  when  we  ex- 
amine the  subjective  symptoms,  and  extreme  caution  is  then 
needed,  besides  the  adoption  of  the  most  delicate  tests,  which 
should  be  repeatedly  made  use  of,  until  we  are  satisfied  as  to 
what  is  the  real  condition  of  the  patient. 

Fcii^licd  Pain. — There  is  probably  no  symptom  so  com- 
monly complained  of  and  none  so  easy  to  present,  as  that  of 
pain.  Being  purely  subjective  the  examining  physician  is  fre- 
quently tried  to  his  utmost,  and  much  depends  upon  his  knowl- 
edge of  human  nature  ;iiitl  his  ])tTceptive  faculties.  The  ]iain 
of  the  simulator  is  unsubstantial  and  inconsistent  as  a  rule  with 
that  which  would  arise  in  any  anatomo  ])athological  situation. 
His   attempts  at   localization  therefore  are  very  vague  and  un- 


FVSi-rEROID    STATES    AND    FEIGNED    DISEASES  20  1 

certain  or  he,  on  the  other  hand,  is  almost  too  accurate  in  the 
description  of  his  sufferings.  A  neuralgia,  for  instance,  is  lo- 
cated in  a  situation  where  no  nerve  trunk  lies;  or  a  sciatica 
may  be  rete'".Ted  to  the  outside  of  th.e  thigh,  as  it  was  by  a  wo- 
man I  examined  the  other  day,  or  to  some  other  equally 
unlikely  place  The  neuralgia  of  the  malingerer  has  no 
paroxysms  or  intermissions,  and  is  not  attended  by  any  of  the 
vascular  citaneous  changes  that  so  often  exist  in  the  genuine 
disease,  Ther*.  are  no  points  doloreux  or  at  least  none  that 
correspond  with  the  anatomical  situation  at  which  we  would 
expect  to  find  them.  The  pretender  says  that  his  pain  is  ag- 
gra.va.ted  by  muscula'"  movements,  when,  after  all,  such  move- 
ments ordinarily  have  nothing  to  do  with  the  increase  of  pain 
in  the  real  affection.  His  expressions  of  suffering  are  much 
m,ore  demonstrative  when  he  has  an  idea  that  he  is  under  ob- 
servation, and  when  his  attention  is  diverted  he  apparently  suf- 
fers but  little  or  none,  and  often  we  are  unable  to  find  any  facial 
or  other  bodily  indications  of  distress.  Pressure,  even  of  the 
lightest  kind,  produces  great  torture  for  the  simulator,  just  as 
it  does  in  hysteria,  although  the  hyperesthesia  of  the  former 
is  not  real  nor  is  it  associated  in  pure  cases  of  malingering  with 
other  symptoms,  at  least  with  other  symptoms  that  are  classical 
and  pathognomonic;  yet  when  the  same  pressure  is  made  and  the 
patient's  attention  is  diverted,  he  no  longer  complains  of  the 
pressure  made  upon  the  original  point  of  contact,  but  fixing 
his  attention  upon  a  new  point  refers  his  suffering  to  the  latter. 
Direct  questioning  or  hints  skillfully  thrown  out  may  cause  the 
dishonest  person  to  let  his  imagination  run  wild,  and  by  encour- 
aging the  play  of  expectant  attention,  especially  if  the  subject 
be  a  woman,  the  deception  becomes  cleax 

A  lavorite  seat  of  pretended  suffering  is  the  back  ;  and,  as 
I  have  already  said,  we  often  find  that  the  dishonest  individual 
sometimes  refers  his  pains  to  the  abdomen  as  well.  If  we  have 
the  simulator  carefully  watched,  our  suspicions  will  often  be 
confirmed,  and  it  will  be  found  that  when  he  thinks  he  is  not 
under  observation  he  will  be  able  to  do  pretty  much  anything  he 
chooses  ;  but  when  he  comes  into  court,  or  when  he  applies  to  a 
medical  officer  for  privileges  he  desires,  his  complaints  are  re- 
doubled and  sometimes  very  ridiculous.  In  this  connection  I 
will  mention  the  case  of  a  woman  who  had  been  told  that  Pott's 
disease  was  accompanied  by  a  tendency  upon  the  part  of  the 
patient  to  support  the  chin  for  the  relief  of  the  pain.  Although 
she  had  frequently  been  examined  by  medical  men,  nothing  of 
this  kind  had  been  found  to  exist.    When  she  appeared  in  court 


^02  MEDICAL    TURISFP.UDENCK 

during  the  tnalot  her  ?'j it  for  damages,  she  studioi.isly  supported 
her  chip,  but  when  she  was  in  the  corridors  of  the  court  house 
and  at  home  she  neglected  to  maintain  the  deception. 

The  simulation  of  hip-joint  disease  is  quite  common,  but 
the  pain  is  as  a  rule  improperly  referred^  and  that  in  the 
knee,  which  is  one  of  the  most  important  and  constant  accom- 
panini.ents  of  real  trouble,  is  not  mentioned  at  all  by  the 
impostor.  So,  too,  when  rheumatism  is  feigned,  or  in  fact 
where  the  pain  of  other  inflammatory  conditions  is  clamied 
to  exist,  none  of  the  signs  of  swelling,  heat,  or  redness,  will  be 
found,  and  movement  of  the  limb  is  at  all  times  unembarrassed. 
A  person  who  will  complain  of  a  back  pain  that  may  be 
mistaken  for  that  of  spinal  disease,  and  from  the  acuteness 
of  which  we  may  suspect  menmgitis  ;  will  manifest  none  of 
the  rigidity  and  stiffness  ot  movement  which  in  ninety  nine 
cases  out  of  a  hundred  is  a  characteristic  of  inflammation 
of  the  spinal  envelopes.  There  are  none  of  the  constitutional 
expressions  or  results  of  severe  pain  ;  such  as  sleeplessness  and 
increase  of  temperature  ;  and  the  functions  of  the  bowels  and 
kidneys  are  not  affected.  We  neither  find  in  the  urine  increase 
of  phosphatic  matter  nor  the  urates.  The  patient  will  often 
complain  that  certain  forms  of  movement  cause  intolerable 
suffering  and  misery,  yet  we  may  ascertain  that  he  or  she  may 
make  exertion  of  a  much  more  severe  kind,  in  which  the  same 
muscles  and  the  same  parts  are  exercised  without  any  of 
the  corresponding  complaint.  A  young  lady,  desiring  to 
escape  her  piano  ])ractice,  complains  of  pain  in  one  arm  and 
shoulder,  and  gains  the  sympathy  of  her  unthinking'  mother, 
while  the  same  day  she  may  devote  one  or  two  hours  to  lawn- 
tennis  or  use  her  hands  in  other  ways  and  give  no  report  of 
pain. 

Fodere  refers  to  numerous  cases  where  malingerers  have 
shirked  their  duty,  alleging  inability  because  of  pain.  He  re- 
jjorts  the  case  of  an  artillerist  who  was  brought  to  the  hospital 
at  Martignes  complaining  of  violent  pain  in  the  left  leg, 
which  it  is  supposed  resulted  from  exposure  and  lying  upon 
the  damp  ground.  Treatment  was  indicated  and  followed 
up  ;  blisters  and  other  powerful  agents  were  exhibited,  and  it 
was  supposed  that  his  leg  had  become  thinner  and  shorter  than 
the  other.  Finally  he  was  discharged  and  left  the  hospital 
upon  a  crutch.  When  he  reached  Marseilles  he  learned  of  his 
discharge,  and,  unable  to  restrain  his  emotions  and  his  great 
joy,  he  threw  away  his  crutches  and  walked  briskly  without 
any  limp  or  sign  of  trouble.     He  had,  liowever,  miscalculated, 


HYSTEROID    STATES   AND    FEIGNED    DISEASES.  203 

for  he  encountered  the  commandant  of  the  fort,  and  was  ar- 
rested and  imprisoned,  and  subsequently  acknowledged  his  de- 
ception. 

The  malingering  patient  will  sometimes  give  a  clue  to  his  de- 
ceit and  the  unsubstantiality  of  his  symptoms  by  his  disincli- 
nation to  have  anything  done  for  him,  probably  believing,  as  it 
were,  that  the  disappearance  of  his  symptoms  would  be  the  loss 
of  his  stock  in  trade.  Occasionally  the  reverse  is  true,  espec- 
ially where  a  claim  is  made  for  damages,  and  in  such  cases  the 
impostors  seek  every  occasion  to  express  their  desire  for  relief. 
It  is  common  for  such  a  person  to  say  :  "I  would  give  ten 
thousand  dollars  if  this  pain  were  absent  ;  "  and  this  is  some- 
times very  ludicrous  when  it  comes  from  the  lips  of  a  slatternly 
boarding  house  keeper  or  a  poor  clerk  who  receives  a  few  dol- 
lars a  week  as  salary. 

Beck  refers  to  the  case  of  a  girl  fifteen  years  of  age  who 
complained  of  a  pain  just  back  of  the  symphysis  of  the  lower 
jaw.  The  result  was  that  she  was  taken  from  school  and 
she  carried  her  point.  When  affecttd  subsequently  a  strong 
mental  impression  was  made  by  Dr.  Thompson  who  attended 
her,  and  it  was  based  upon  the  great  antipathy  she  had  to  a 
dog.  She  was  informed  that  the  only  remedy  remaining  was  to 
rub  the  affected  part  over  the  back  of  that  animal.  The 
result  was  complete  and  immediate  cure,  without  recourse  to 
the  prescription.  But  such  cases  as  this  are  the  ones  most 
easily  detected. 

Mr.  Hutchinson  Upon  Malingerers. — Mr.  Hutchinson 
thus  speaks  of  malingering,  after  laying  down  certain  rules  for 
the  detection  of  impostures,  and  advising  those  who  meet  such 
cases  that  it  is  better  for  the  time  to  assume  that  the  patient's 
sickness  is  true  than  to  make  the  mistake  of  overlooking  a  gen- 
uine disease.  "  The  imi)ortance  of  this  rule,"  says  he,  "can 
scarcely  be  exaggerated  in  its  application  to  the  casualty  room 
of  large  hospitals.  It  is  far  better  to  allow  nineteen  knaves  a 
temporary  success  in  their  schemes  than  to  refuse  relief  to  one 
really  urgent  sufferer.  Cases  come  very  frequently  under  my 
notice  in  which  great  hardship  would  have  been  inflicted  had 
the  suspicion  of  malingering  been  hastily  acted  upon.  This 
rule,  however,  must  of  course  only  be  allowed  to  apply  to  mild 
measures  of  treatment.  Malingerers  of  a  certain  class,  espec- 
ially hysterical  women,  will  often  submit  with  eagerness  to  most 
painful  measures  of  treatment,  or  even  to  those  which  entail 
permanent  deformity.     In  all  such  cases  the  surgeon's  duty  to 


204  MEDICAL    JURISPRUDENCE. 

withstand  the  patient's  importunacy  is  clear.  A  man  is  at  pres- 
ent in  one  of  the  surgical  wards  who  has  had  his  fore-arm  am- 
putated for  injury.  He  now  complains  of  a  painful  stump,  and 
avers  that  the  pain  is  such  as  to  prevent  his  rest  night  and  day  ; 
he  is  most  desirous  that  another  amputation  should  be 
performed.  He  is,  however,  apt  to  be  dismissed,  in  the  belief 
that  he  has  intentionally  exaggerated  his  symptoms.  The  fol- 
lowing reasons  support  this  view  :  i.  He  has  not  the  slightest 
aspect  of  suffering  want  of  rest.  2.  He  complains  of  pain  in 
the  muscles  of  the  part  removed,  not  in  the  skin,  and  whenever 
his  stump  is  examined,  he  always  puts  the  remaining  pairs  of 
muscles  below  the  elbow  into  constant  action,  alternately  relax- 
ing and  contracting  them  in  a  manner  ^yhich  can  be  no  other 
than  voluntary.  3.  He  has  never  on  any  occasion  given  a  cor- 
rect guess  as  to  the  distribution  of  any  one  of  the  sensory 
nerves  of  the  fore-arm,  but  is  obliged  to  refer  the  pain  to  the 
whole  hand  and  wrist.  It  is  improbable  that  the  median, 
radial  and  ulnar  should  be  neuralgic  at  the  same  time.  His 
case,  however,  confirms  the  remark  that  most  forms  of  maling- 
ering are  based  upon  some  real  loss  and  often  upon  some  real 
disease  still  in  existence  ;  they  are  intentional  exaggerations, 
rather  than  fictions  pure  and  simple."  Hutchinson's  views  are 
undoubtedly  correct,  but  so  far  as  my  own  experience  has  gone 
the  primary  injuries  or  conditions  are  in  inverse  ratio  to  the 
complaints,  and  this  makes  the  fraud,  especially  where  there  is 
a  well  formed  motive  or  object  to  be  gained,  more  easy  of  de- 
tection. 

Real  Disease  Apparently  Feigned. — An  unfortunate 
mistake  to  make  is  that  of  considering  the  symptoms  of  real 
disease  to  be  fictitious  manifestations,  and  the  books  contain 
examples  where  the  patient's  subsequent  history  contradicted 
the  doctor's  original  diagnosis. 

Danger  of  making   a  hasty  Diagnosis. — "  Dr.  James 

Johnson  reports  the  case  of  a  man  who  complained  of  in- 
ability to  move  his  shoulder  joint  without  much  pain  ;  and 
yet  nothing  could  be  seen  externally  for  a  month  or  six 
weeks,  during  which  time  he  was  excused  from  duty.  At 
length  the  surgeon  became  suspicious,  and  finding  that  he  still 
made  the  same  complaint,  reported  him,  and  he  was  (logged  as  a 
skulker.  Shortly,  however,  a  deep  seated  abscess  was  discovered 
in  the  shoulder  joint,  from  which  large  quantities  of  pus  were 
evacuated  and  ankylosis  of  the  joint  followed."  The  case 
occurs  to  me  of  a  person  who  was  injured  and  examined  by 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  205 

another  physician  His  primary  symptoms,  it  is  true,  were  not 
those  which  would  impress  the  careless  observer.  He  com- 
plained of  ill-defined  pains,  formication  and  loss  of  power  in 
the  lower  limbs,  and  his  gait  was  somewhat  uncertain  and 
"ketchy."  The  physician  who  examined  him  pronounced  the 
case  one  of  imposture,  but  the  appearance  within  two  or  three 
years  of  very  marked  spastic  paralysis,  with  aggravation  of  the 
reflexes  confirmed  my  original  opinion  of  lateral  sclerosis  of  the 
spinal  cord. 

Feigued  Spasmodic  Affections. — It  is  rare  for  malinger- 
ers to  simulate  chorea  or  other  spasmodic  disorders,  and  if  they 
do  it  will  be  found  that  the  movements  are  chiefly  of  a  voluntary 
character,  and  the  pretended  malady  is  unaccompanied  by  any 
evidences  of  valvular  disease  so  common  in  true  affection.  The 
reader  is  referred  to  the  chapter  on  epilepsy  and  insanity  for  a 
description  of  feigned  disease  of  this  kind. 

Tetanus,  hysteria  and  hydrophobia  are  imitated  with  more  or 
less  success  by  the  impostor,  but  a  slight  knowledge  of  the 
symptoms  of  these  diseases  is  all  that  is  required  to  settle  the 
question  of  trickery.  In  the  genuine  diseases  we  flnd  a  rise  of 
temperature  which  cannot  be  discovered  in  the  individual  who 
simulates  ;  and  though  the  patient  who  feigns  tetanus  and  hy- 
drophobia may  copy  with  some  fidelity  the  opisthotonos  which  he 
has  heard  is  a  conspicuous  feature  of  these  nervous  disor- 
ders, he  nearly  always  neglects  the  throat  symptoms,  and  the 
muscular  contractions  are  not  consistent  in  their  association 
or  extent  with  the  rigidity  which  he  attempts  to  exhibit. 

Feiglietl  \jVLtQ\\'^tiQW'^Xi.^^'^.  — Unconsciousness  is  sometimes 
feigned  and  so  closely  as  to  deceive  the  most  watchful  observer 
although  in  many  cases  the  activity  of  the  pulse  will  betray  the 
lively  emotional  condition  of  the  patient.  It  is  possible  for  a 
clever  person  to  control  the  manifestation  of  the  excitement 
which  is  usually  created  by  the  appearance  of  a  new  person,  es- 
pecially a  physician. 

Yoluutary  Arrest  of  tlie  Heart's  Action. — Beck 
speaks  of  a  man  who  could  produce  an  apparent  stoppage  of  heart 
action  when  he  feigned  death. 

The  case  of  the  negro  Thomas  White  which  is  so  admirably 
described  by  Dr.  Michel*  is  one  of  great  interest.  This  man 
was  able  to  arrest  his  heart  and  pulse  at  the  wrist  by  tak- 
ing  a  very  deep  inspiration    and  suspending   his   breath.     Dr. 

*  Boston  Medical  and  Surgical  youfnal,  Oct.  31,  187S. 


jo6  MEDICAL    JURISPRUDENCE. 

Michel  also  presents  the  case  of   the  Hon.  Col.  Townshend  re- 
ported by  Cheyne,  and  that  of  a  Mr.  Grew  of  Charleston. 

"  The  case  of  the  Hon.  Colonel  Townshend  comes  to 
us  through  one  of  his  physicians,  Doctor  George  Cheyne, 
author  of  a  Treatise  on  Nervous  Diseases,  who  was  called  with 
Dr.  Baynard  to  see  this  gentleman  at  the  Bell  Inn,  upon  his  ar- 
rival at  Bath  from  Bristol.  At  one  of  their  visits,  while  Mr. 
Skrine,  the  apothecary,  was  present,  the  colonel  stated  that  he 
could  die  or  expire  when  he  pleased,  and  yet  by  an  effort  he 
could  come  to  life  again,  and  asked  an  explanation  of  the  phe- 
nomenon ;  but  as  he  was  weak  and  sick,  these  gentlemen  with 
reluctance  assented  to  his  making  the  trial.  While  he  prepared 
himself  for  so  strange  an  exhibition  Dr.  Cheyne  held  the  pulse, 
Dr.  Baynard  examined  the  heart,  and  Mr.  Skrine  placed  a  mir- 
ror to  the  mouth  ;  the  pulse  sank  until  it  could  not  be  felt,  all 
motion  of  the  heart  ceased,  and  not  the  least  soil  of  breath  on 
the  bright  mirror  was  detected.  Then  each  in  turn  examined 
the  arm,  heart  and  breath,  but  could  not  discern  the  least  symp- 
tom of  life.  He  remained  in  this  condition  for  a  half  hour, 
when  the  functions  of  respiration  and  circulation  were  gradually 
reinstated. 

"  Some  years  ago  I  was  invited  by  Professor  Frost,  then  dean 
of  the  medical  college  at  Charleston,  to  meet  the  faculty  by  ap- 
pointment to  examine  a  Mr.  Grew,  in  whom  there  was  an  ar- 
rest of  development  of  the  sternum.  Besides  many  interesting 
facts  concerning  the  play  of  the  heart,  which  were  readily  de- 
termined through  the  simple  inlegumenlal  covering  which  alone 
separated  us  from  that  organ,  we  had  an  opportunity  of  witness- 
ing a  like  experiment  upon  the  suspension  of  this  heart's  action 
and  subsidence  of  the  pulse.  When  he  took  a  deep  inspiration 
and  then  held  his  breath,  the  pulse  grew  weaker  and  weaker, 
and  finally  stopped  entirely,  while  the  ear  over  the  precordial 
region  could  not  detect  the  slightest  impulse  or  sound.  The 
heart  had  ceased  all  action,  and  there  was  temporarily  no  pulse 
throughout  the  system." 

It  is  important  to  recognize  this  trick,  and  I  have  several 
times  seen  it  attempted  by  medical  students  and  others. 

Tlie  Wllittaker  Case. — It  is  sometimes  the  object  of  ma- 
lingerers to  affect  unconsciousness  for  the  purpose  of  carrying 
out  some  scheme  to  gain  sympathy,  and  occasionally  we  find  self- 
mutilation  to  be  a  part  of  the  i)lan.  An  interesting  case  of  this 
kind  is  that  of  the  colored  cadet  VVhittaker  who  was  tried  some 
time  ago  in  this  city.     Whittaker  was  one  of  the  few  colored 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  207 

cadets  who  went  to  West  Point  and  one  of  the  least  intelligent. 
He  had  repeatedly  failed  in  his  studies  and  upon  the  eve  of  an 
examination  which  would  undoubtedly  result  in  his  sus- 
pension, he  made  a  desperate  attempt  to  gain  the  sympathy  of 
the  country,  as  well  as  the  opportunity  to  secure  time  for 
extra  study.  As  the  medical  counsel  for  the  government  I  had 
ample  opportunity  to  examine  not  only  the  record  of  the  Court 
but  I  made  a  personal  visit  to  his  room  at  West  Point.  The 
defendant  was  found  early  one  morning  in  his  dormitory,  bound 
to  his  bed  with  strips  of  cotton  cloth,  in  an  apparently  uncon- 
scious state.  His  eyes  were  closed  and  his  pulse,  which  was  ex- 
amined, showed  nothing  unusual.  There  were  slight  cuts,  one 
upon  the  left  ear  and  the  other  across  the  great  toe.  He  re- 
mained apparently  oblivious  of  his  surroundings  and  of  the  peo- 
ple about  him  for  some  time,  and  finally  opened  his  eyes  and 
in  a  dazed  condition  expressed  great  surprise.  From  his  story 
it  appeared  that  he  had  been  surprised  se'veral  hours  before  by  a 
body  of  masked  men  who  felled  him  to  the  floor,  bound  him,  and 
cut  his  ears  and  toe,  and  then  after  threatening  him  left  the  room. 
The  medical  witnesses  for  the  defense  were  of  the  opinion  that 
the  threats  of  the  assailants,  the  fears  of  the  victim  and  the  ex- 
citement had  resulted  in  the  production  of  trance  !  Much  care- 
fully given  evidence  effectually  disposed  of  this  fanciful  theory. 
It  was  proved  that  none  of  the  wounds  were  of  a  serious  charac- 
ter, in  fact  they  were  all  painless  and  trivial,  and  unattended 
by  hemorrhage  ;  that  on  the  toe  hardly  severed  the  skin.  They 
were  in  a  situation  in  which  he  could  have  made  them  himself, 
and  the  presence  of  a  razor  and  a  looking-glass  on  ihe  floor  near 
him  strengthened  this  belief.  No  marks  of  violence  resulting 
from  a  struggle  were  found,  and  the  bandage  was  so  loosely 
applied  and  so  flimsy  that  he  might  have  readily  applied  it 
himself,  in  fact  a  young  officer  went  through  the  process  of 
tying  and  untying  himself  as  Whittaker  had  probably  done. 
The  room  in  which  the  alleged  assault  had  taken  place  had 
numerous  openings  communicating  with  other  apartments,  in 
which  many  cadets  were  at  the  time,  and  any  disturbance 
would  have  been  heard  at  once.  A  prominent  feature  of  the  case 
was  the  production  of  a  letter  of  warning  sent  to  the  prisoner 
which  it  was  alleged  was  written  by  Whittaker,  and  this  drew 
forth  a  fight  between  the  experts  in  handwriting. 

After  the  trial  I  learned  from  an  expert  to  whom  several  of 
Whittaker's  letters  had  been  sent  for  comparison,  that  among  the 
number  was  one  which  with  t]ie  exception  of  the  erasures  and 
interlineations,  exactly  resembled  the   "letter  of  warning"  pro- 


2o8  MEDICAL    JURISPRUDENCE. 

duced  in  Court.  This  was  written  by  a  young  woman  to  the 
prisoner,  and  it  is  presumed  that  the  celebrated  letter  in  evi- 
dence was  the  joint  production  of  the  two.  The  prisoner  was 
found  guilty,  but  his  sentence  was  modified. 

Tests  for  Feigned  Unconsc  iousness. — For  the  detec- 
tion of  shammed  unconsciousness  we  are  to  apply  tests  of  a 
sensory  character,  and  among  these  may  be  noted  the  faradic 
current  with  the  wire  brush,  the  use  of  pins  or  needles,  and  per- 
haps the  actual  cautery.  The  threat  to  use  this  last  instrument 
may  be  sufficient  to  bring  the  impostor  to  his  wits.  In  a  case 
related  by  Smith,  and  quoted  by  Beck,  Gavin  and  others,  a 
man  named  Drahe  who  had  feigned  total  insensibility  for 
months  and  had  refused  to  be  made  to  see  the  error  of  his  ways 
by  the  introduction  of  aloes  beneath  his  tongue,  the  shower 
bath  and  electricity,  promptly  recovered  when  the  hot  iron  was 
suggested,  the  first  indication  of  his  altered  emotional  state  be- 
ing the  rise  in  his  pulse. 

Sometimes  the  patient  feigns  unconsciousness  for  the  purpose 
of  escaping  punishment,  and  the  case  of  Phineas  Adams*  a 
deserter  who  remained  apparently  unconscious  for  over  two 
months,  is  one  illustrating  the  difficulties  that  a  determined 
man  will  place  in  the  way  of  the  medical  observer. 

With  Adams  every  species  of  revulsion  was  used,  snuff  was 
blown  into  the  nostrils,  electric  shocks  used,  pins  were  run  under 
the  finger  nails.  It  was  even  threatened  in  his  hearing  that  an  oper- 
ation was  to  be  performed  for  the  purpose  of  removing  his 
scalp  to  see  whether  there  was  fracture  of  the  skull  or  not.  He 
permitted  himself  to  be  cut  into  and  gave  no  sign  of  suffering 
except  when  the  scalp  was  scraped,  when  he  groaned.  No  re- 
sults occurring  from  the  treatment  or  examination,  he  was  dis- 
charged and  sent  to  his  father's  house.  He  was  seen  the  day 
after  helping  his  father  to  thatch  a  rick.  In  feigned  uncon- 
sciousness the  muscular  condition  must  be  observed,  the  state  of 
the  pupils  is  also  to  be  noted  and  the  general  condition  of  the 
skin,  pulse  and  temperature  are  to  be  investigated.  The 
sphygmograph  may  prove  to  be  a  useful  instrument  in  some 
cases. 

Trance. — The  medico-legal  relations  of  trance  have  been  dwelt 
upon  by  writers  upon  Medical  Jurisprudence,  but  it  is  very  rare 
that  such  an  excuse  can  be  given  for  the  active  commission  of 
a  crime.     It  might  be  possible  to  account  for  the  ignorance  of 

*  Edinburgh  Annual  Register,  Vol.  4,  No.  2  and  Beck. 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  209 

an  individual  by  the  fact  of  his  being  unconscious,  oi  being 
thrown  into  a  state  of  suspended  consciousness  through  fright 
or  a  strong  moral  impression. 

There  is  a  case  related  which  has  some  interest  in  the  fact  that 
the  patient  claimed  to  be  mesmerized  when  he  committed  a  theft. 
A  young  man  had  been  arrested  for  stealing  a  sheet.  When  he 
was  brought  into  Court  he  seemed  pale  and  unable  to  stand 
without  support,  and  his  eyes  were  closed  and  he  appeared  to 
be  in  a  sound  sleep,  and  apparently  did  not  understand  the 
questions  put  tc  him  by  the  magistrate.  It  was  testified  by  the 
police  officer  who  arrested  him  that  he  had  fallen  into  this 
state  after  his  arrest  in  the  station-house,  although  before  this 
he  had  given  an  account;  of  himself.  Medical  aid  was  sent  for 
but  nothing  could  be  done  to  arouse  him  from  his  sleep  (?). 
The  prisoner  had  been  arrested  while  trying  to  pawn  the  sheet 
which  had  been  stolen  from  his  landlady  who  was  a  laundress. 
One  of  the  police  officers  knowing  that  a  brother  of  the  pri- 
soner was  a  lecturer  upon  mesmerism  sent  for  him,  but  the  bro- 
ther was  unable  to  arouse  him,  although  he  answered  questions 
readily.  The  brother  stated  that  the  thief  had  been  susceptible 
for  a  long  time  to  mesmeric  influence  and  could  by  looking 
steadily  at  one  object  for  some  time  go  into  an  unconscious 
condition  ;  that  upon  one  occasion  he  became  violent  during  an 
attack  and  had  to  be  restrained. 

The  prisoner  subsequently  recovered  and  was  tried,  mean- 
while having  gone  wit;hout  food  for  several  days  and  had  not 
asked  for  nourishment  of  any  kind.  The  plea  that  the 
patient  was  incapable  of  knowing  the  difference  between 
right  and  wrong  at  the  time  of  the  theft  was  advanced,  but 
did  not  hold,  for  the  man  was  sentenced  to  fine  and  imprison- 
ment. 

In  this  case  the  question  of  the  criminal  act  arises,  and  its 
execution  seems  to  have  little  to  do  with  expectant  attention. 
An  act  of  violence,  had  it  been  committed,  would  have  suggested 
criminal  irrresponsibility,  but  theft  implie-i  pcrso.ial  benefit. 
I'he  long  continuation  of  the  patient's  alleged  mental  state,  and 
his  interval  of  lucidity  when  he  told  his  story  at  the  station- 
house,  threw  suspicion  upon  his  conduct.  It  is  probable  that  the 
verdict  was  a  righteous  one. 

Feigued  Somnambulism. — Feigned  somnambulism  is 
more  common  than  feigned  trance  and  it  may  readily  be  seen 
how  a  criminal  surprised  in  the  performance  of  a  crime  at  night 
may  resort  to  this  species  of  deception. 

14 


210  MEDICAL    JURISPRUDENCE. 

Gavin  '*  thus  refers  to  an  interesting  case  of  feigned  somnam- 
bulism : 

''  A  remarkable  case  of  feigned  somnambulism  is  related  by 
Recherz  and  Kriiza.  A  rope-maker  twenty-three  years  of  age, 
was  often  attacked  with  a  profound  sleep,  in  the  middle  of  his 
occupation;  whether  seated,  standing,  or  walking ;  he  then 
knitted  his  brows,  gradually  closed  his  eyelids,  and  began  to  re- 
peat everything  he  had  done  during  the  day,  from  his  morning 
prayer  up  to  the  time  of  the  occasion  ;  for  example,  he  simu- 
lated the  movements  of  a  man  who  puts  on  his  stockings  and 
shoes,  cleans  his  dress,  etc.  If  the  sleep  overtook  him  whilst 
walking  in  the  country,  he  pursued  his  journey  with  as  much 
assurance  as  if  he  had  been  awake,  avoiding  persons  and  ob- 
jects which  could  have  hurt  him,  etc.  The  story  is  reported 
with  these  circumstances  and  even  others,  without  any  suspic- 
ion of  the  fraud.  Now  two  circumstances  alone  among  these 
would  have  caused  suspicion,  the  first  is,  that  the  man  repeated 
in  his  pretended  accession,  all  that  he  had  done  during  the 
day  ;  a  circumstance  contrary  to  that  which  is  observed  in  true 
somnambulists,  who  only  execute,  in  the  accession,  those  things 
which  they  have  premeditated,  or,  which  have  previously 
strongly  occupied  their  thoughts.  The  second  is  that  this 
young  man  played  a  double  game  ;  he  repeated  that  which  he 
had  done  from  the  first  part  of  the  day  up  to  the  period  of  ac- 
cession, then  continued  that  which  he  was  about  to  do  when  the 
accession  overtook  him.  The  trick  was  finally  discovered.  The 
man  professed  himself  cured,  when  a  physician,  charged  with 
his  examination,  proposed  to  bandage  his  eyes,  to  ascertain  if 
he  was  still  able  in  that  state  to  execute  actions  which  hitherto 
had  excited  so  much  surj^ise." 

Where  somnambulism  has  been  simulated,  according  to  Du 
SauUe,  it  is  for  the  purpose,  first,  of  accomplishing  an  act  it 
would  be  difficult  or  impossible  to  execute  at  other  times  ;  sec- 
ondly, to  escape  a  just  punishment  for  a  reprehensible  or  com- 
promising act  ;  thirdly,  to  excite  commiseration  and  to  fraudu- 
lently obtain  assistance  ;  the  falsehood  and  trick  are  not  always 
easily  detected. 

Feigned  locomotor  Ataxia. — Locomotor  ataxia  has 
been  simulated  and  Lataud  reports  the  case  of  a  soldier  who 
attempted  to  avoid  military  duty  by  this  method  of  deception. 
In  such  cases  it  will  be  found  that  the  tendon-reflex  is  present, 
that   no  pupillary  or  optic  nerve  changes  exist,  and  in  all  prob- 

*  l^'eigned  Diseases,  p.  II2. 


HYSTEROID    STATES   AND    FEIGNED    DISEASES.  211 

ability  the   patient  will   not  bear  such  tests  as  being  told  to 
walk  in  the  dark  or  to  stand  with  his  eyes  closed. 

Feigned  Paralysis. — It  is  a  common  thing  for  persons  who 
claim  that  they  suffer  from  injuries  to  sham  paralysis,  and  the 
form  chosen  is  either  paraplegia  or  local  paralysis.  In  such 
cases  it  will  be  found  that  there  is  usually  more  or  less  rigidity, 
that  there  is  no  atrophy  and  that  the  electric  currents  will  pro- 
duce their  customary  reactions.  Under  the  influence  of  an 
anesthetic  the  patient  will  move  the  limbs  and  this  is  an  im- 
portant test,  that  however  can  rarely  be  employed  except  in  the 
public  service.  It  sometimes  happens  however  that  an  amount 
of  cunning  will  be  shown,  especially  in  cases  where  there  are  some 
grounds  for  believing  the  person  in  earnest,  Avhich  may  throw 
the  medical  man  off  his  guard.  As  an  interne  I  once  treated  a 
patient  who  was  brought  to  the  hospital  in  a  helpless  condition. 
He  had  received  a  bullet  wound  in  the  back  while  engaged 
in  a  burglary,  and  upon  his  admission  he  could  neither  move 
his  legs  nor  feel  the  point  of  a  pin.  The  bullet  had  entered  near 
the  sixth  dorsal  vertebra  upon  one  side  but  could  not  be  found. 
While  under  observation  there  were  no  vesual Siud  r^^/^s;/ symp- 
toms and  he  had  no  erections.  After  a  stay  of  several  weeks 
there  was  no  pathological  atrophy  and  the  electric  reactions 
were  good.  Numerous  consultations  were  held  at  his  bedside 
which  he  listened  to  and  he  seemingly  took  a  great  interest  in 
his  case.  He  was  finally  carefully  removed  upon  a  stretcher  to 
the  gaol  to  be  cared  for  by  the  physician  of  that  building  and  when 
he  left  us  could  apparently  not  move  his  legs.  The  night  after 
his  removal,  however,  he  broke  out  of  his  cell,  scaled  a  wall, 
dropped  to  the  ground  and  found  his  way  to  parts  unknown. 
In  this  case  there  was  every  reasonable  ground  to  believe  the 
patient's  case  was  a  serious  one — though  the  absence  of  local 
and  general  symptoms  was  suspicious. 

Simulators  are  apt  to  keep  their  paralytic  arms  rigid  or  to  re- 
sist attempts  made  to  bend  them.  Hutchinson  has  shown  that 
a  healthy  arm  trembles  when  a  heavy  weight  is  attached  to  it, 
which  is  not  the  case  in  paralysis. 

Feigned  Hemiplegia. — Gavin  thus  speaks  of  feigned  hemi- 
plegia : 

"  In  suspicious  cases  of  hemiplegia,  our  inquiries  must  em- 
brace the  origin  of  the  attack,  its  nature  and  course.  Whether 
arising,  i,  from  apoplexy  ;  2,  or  likely  to  precede  it  ;  3, 
whether  characterized  by  previous  symptoms,  such  as  pain  in 
the  head,  disorder  of  the  intellectual  powers,  spasmodic  twitch- 


212  MEDICAL   JURISPRUDENCE. 

ings  ;  4,  whether  gradually  supervening  in  persons  in  advanced 
life  ;  5,  whether  preceded  by  a  train  of  anomalous  and  perplex- 
ing symptoms  having  a  relation  to  chorea,  or  fits  of  an  epileptic 
character  ;  or,  6,  whether  succeeding  at  some  period  after  the 
receipt  of  an  injury. 

"  In  the  attack  itself,  if  with  the  loss  of  voluntary  power  over 
the  upper  and  lower  extremity,  we  do  not  recognize  paralysis  of 
the  side  of  the  face,  a  drawing  of  the  mouth  to  the  sound 
side,  more  or  less  upwards,  a  curve  of  the  tongue  when  pro- 
truded, convexity  being  toward  the  affected  side  ;  an  increasing 
dilatation  of  the  nostril  of  the  sound  side,  which  is  not  equaled 
by  that  of  the  paralyzed,  when  a  long  inspiration  is  made  ;  the 
peculiar  pointing  of  the  foot  when  it  falls,  as  it  were,  by  its  own 
gravity  ;  adduction  of  the  affected  arm,  and  slight  flexion  of 
the  forearm,  wrist,  and  fingers  ;  we  have  every  reason  to  be- 
lieve the  case  pretended. 

"  In  pretended  hemiplegia,  asserted  to  be  the  result  of  an  injury 
to  the  head,  the  simulator  is  not  likely  to  be  aware  that  the  par- 
alysis should  occur  on  the  side  opposite  to  that  injured." 

The  London  Lancet  of  February,  1872,  page  219,  contains 
an  extraordinary  and  amusing  case  of  malingering  so  success- 
fully carried  out  as  to  secure  admission  of  the  impostor  into 
many  of  the  London  and  Provincial  hospitals,  and  while  thus 
an  inmate  he  was  the  recipient  of  marked  attention  and  sympathy 
from  the  hospital  physicians  and  surgeons,  and  also  what  prob- 
ably pleased  him  as  much,  considerable  whiskey,  brandy,  best 
wine,  and  table  delicacies.  He  is  described  as  a  well-educated, 
clever,  intelligent  man,  with  some  knowledge  of  Latin  and 
Greek,  as  well  as  of  modern  languages.  He  would  represent 
himself  as  a  chemist,  medical  man,  engineer,  in  fact  he  was  all 
things  to  all  men.  He  is  described  as  follows  :  "  He  is  a  stout, 
good  looking,  short-necked  man,  reminding  one  rather  forcibly 
of  the  pictures  of  Henry  VIII.  His  hair  is  dark  brown, 
short,  and  curly  ;  and  he  has  the  scar  of  a  carbuncle  in  the  cer- 
vico-dorsal  region  of  his  back.  Age,  about  forty-three."  He 
would  assume  the  role  of  a  hemiplegic,  or  would  intensely  in- 
terest professors  and  students  by  giving  them  an  exhibition  of 
tetanus,  with  beautiful  risus  sardonicus.  Professors  would  lec- 
ture and  students  would  take  notes  on  his  condition.  "  More 
than  once  (it  is  said)  he  has  been  attended  all  night  by  a  dili- 
gent student,  who  carefully  recorded  all  the  attacks  of  spasms, 
etc." 

He  usually  succeeded  in  securing  a  good  home  in  the  hos- 
pital for  from  one  to  two  weeks,  and  at  the  first  intimation  thrt 


HYSTliKUlD    STATES    AND    FEIGNED    DISEASES.  213 

the  imposition  was  detected  he  would  abscond,  and  he  some- 
times even  had  the  effrontery  to  threaten  to  complain  to  the 
hospital  authorities  that  he  was  ill-treated.  At  one  time  he 
had  a  genuine  carbuncle  on  the  neck,  and  even  then  he  did  not 
forget  to  have  the  tetanic  spasms  and  opisthotonos,  and  "ground 
his  carbuncle  against  the  pillow."  At  this  time,  it  seems,  he 
was  seriously  ill,  and  was  prevailed  upon  to  make  his  will,  giving 
to  the  hospital  and  physicians  considerable  amounts,  after  pro- 
viding for  his  family.  This  generosity  and  gratitude  on  his 
part  of  course  had  its  effect  upon  those  in  attendance,  and  he 
was  fed  on  delicacies  and  wine,  ad  libitum.  The  following 
record  from  the  note-book  of  one  hospital  where  he  was 
an  inmate,  gives  an  example  of  his  methods.  "  Previous  to  the 
appearance  of  the  carbuncle  he  had  enjoyed  excellent  health. 
This  afternoon,  whilst  riding  in  an  omnibus,  he  was  seized  with 
a  violent  spasm,  having  throughout  the  day  felt  considerable 
irritation  in  the  seat  of  the  incision,  and  just  previous  to  the 
attack  a  tingling  sensation  down  the  spinal  column."  From 
that  time  for  many  days  after  he  had  attacks  of  tetanus,  com- 
plete in  every  particular.  The  slightest  changes  were  noted, 
and  students  sat  up  with  him  at  night,  recording  the  slightest 
changes.  After  about  two  weeks  he  left  the  hospital  in  indig- 
nation because  the  nurse  said  she  thought  he  was  shamming. 
He  here  called  himself  Edward  Mason,  M.D.  His  motive  was 
a  matter  of  mystery  to  the  deceived.  As  a  hemiplegic  he  was 
also  a  success  when  he  chose  to  take  on  this  malady,  the  halt- 
ing gait,  the  tongue  deviating  to  one  side  when  protruded,  and 
even  the  post-paralytic  contractions  were  perfect,  but  a  day  or 
so  after  he  had  left  the  hospital  he  might  be  seen  walking  per- 
fectly. 

Beck  relates  the  following  case  : 

"  A  dextrous  deception  was  recently  practiced  upon  the 
Court  of  Sessions  at  Hackensack.  A  fellow  who  had  been  a 
long  while  in  prison,  awaiting  trial  on  an  indictment  for  perjury, 
a  few  days  previous  to  the  time  appointed  had  a  severe  paral- 
ytic stroke,  which  rendered  one  side  entirely  powerless.  In 
this  helpless  condition  he  was  carried  from  the  prison  into 
Court  on  a  bed.  The  spectacle  of  an  infirm  fellow  being, 
trembling  into  the  grave,  on  a  trial  for  perjury,  had  a  visible 
influence  upon  the  sympathies  of  Court  and  jury.  The  evi- 
dence however  was  so  unequivocal  that  the  jury  convicted  him. 
During  the  progress  of  the  trial  he  became  so  faint  that  a 
recess  was  granted,  to  enable  him  to  be  reconveyed  to  his  apart- 
ment in  the  prison  for  revival  ;  the  prosecuting  attorney  kindly 


214  MEDICAL    JURISPRUDENCE. 

lending  assistance.  The  Court,  in  view  of  the  prospect  of  his 
being  speedily  called  to  a  higher  tribunal,  instead  of  sentencing 
him  to  the  State  prison  simply  imposed  a  fine  of  five  dollars, 
which  his  brother,  who  manifested  the  most  fraternal  solicitude, 
paid,  and  conveyed  him  away  in  a  bed,  in  a  wagon.  The  next 
day  the  prosecuting  attorney  encountered  the  fellow  at  the  foot 
of  Cortlandt  street  in  New  York,  who  told  him  laughingly, 
that  he  had  recovered  ;  and  then  dropping  his  arm  and  con- 
tracting his  leg,  in  true  paralytic  style,  hopped  off,  leaving  the 
learned  counsel  to  his  own  reflections.* 

Bartholow  relates  the  case  of  a  malingerer  who  feigned 
paralysis,  and  he  detected  the  fraud  by  surprising  the  patient. 
"  In  passing  by  a  man  in  the  hospital  who  professed  to  have 
paralysis  of  the  left  arm,  I  suddenly  seized  the  paralyzed  limb 
without  his  being  aware  of  my  intention,  and  threv/  it  up. 
Greatly  surprised,  and  taken  off  his  guard  ]ie  exerted  all  his 
force  to  prevent  my  raising  the  arm.  His  imposition  was  at  once 
detected." 

Simulated  Contractures. — Contractures  are  often  feigned 
by  malingerers,  and  a  constant  maintenance  of  the  limb  in  one 
position  may  give  rise  to  a  wasting  which  is  suggestive  of  patho- 
logical atrophy.  There  is  a  stiffness  which,  however,  disappears 
at  night,  and  is  always  increased  when  the  impostor  believes  he 
is  watched.  Sometimes,  however,  it  is  impossible  to  divert  the 
patient's  attention,  or  to  throw  him  off  his  guard.  A  case 
which  eluded  detection  for  a  long  time  is  that  of  "  a  convict  who 
was  confined  on  board  the  Retribution  hulk  at  Woolwich  dur- 
ing the  period  of  his  sentence,  which  was  seven  years.  He 
kept  his  right  knee  bent  so  as  not  to  touch  the  ground  with  his 
foot  all  that  time,  and  he  was  on  that  account  not  sent  to  hard 
labor  with  the  other  convicts.  He  was  commonly  employed  in 
executing  light  jobs,  which  he  could  do  in  a  sitting  ])osture. 
When  he  moved  from  place  to  place  he  hopped  upon  the  left 
foot  with  the  assistance  of  a  stick.  At  the  end  of  the  seven 
years  he  was  discharged,  and  upon  going  away  he  very  coolly 
observed,  *  I  will  try  to  put  down  my  leg,  it  may  be  of  use  to 
me  now.'  He  did  so,  and  walked  off  with  a  firm  step  without 
his  stick,  which  he  had  previously  thrown  away  !  " 

We  shall  sometimes  find  simulated  contractures  of  the  fingers, 
neck,  knees,  etc.,  but,  according  to  Le  Grand  du  Saulle,  we 
shall  find  no  lesion   to   explain  the  contracture,  and  if  we  put 

*  Beck's  Medical  Jurisprudence,  page  14,  1836  ed.  from  N.  J.  newspaper. 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  C15 

the  patient,  when  his  inferior  extremity  is  alleged  to  be 
affected,  upon  a  small  elevated  platform,  we  shall  find  that 
he  begins  to  tremble,  and  that  he  cannot  keep  up  the  decep- 
tion. 

Two  cases  are  related  by  Beck,  one  of  which  was  "  a  man 
who  was  brought  before  a  board  of  medical  officers,  for  the 
purpose  of  being  invalided  if  found  diseased.  It  was  winter,  and 
the  surgeon  proposed  that  the  hand,  in  its  relaxed  and  useless 
state,  might  be  placed  over  the  edge  of  the  table  round  which 
they  were  sitting,  while  the  assistants  should  keep  the  arm  and 
and  shoulder  firmly  fixed.  In  this  situation,  a  red  hot  poker 
was  gradually  brought  under  the  hand.  As  it  came  nearer  and 
nearer,  the  hand  gradually  rose  to  the  full  extent  of  the  power 
of  the  extensor  muscles." 

Another,  "  a  most  obstinate  case,  however,  according  to  Mr. 
Marshall,  was  that  of  a  private,  who  for  two  years  endured 
everything  that  medical  skill  and  suspicion  could  suggest.  His 
complaint  was  paralysis  of  the  lower  .extremities.  He  was 
finally  sent  home  from  the  Mediterranean  to  be  invalided. 
While  in  the  harbor  an  alarm  of  fire  was  given  on  board  ship. 
All  hurried  to  the  boat  alongside,  and  on  reaching  the  quay, 
the  passengers  were  mustered.  It  was  found  that  the  invalid 
had  saved  not  only  himself,  but  his  trunk  and  clothes. 

Feigned  Diseases  Of  WomI). — In  certain  rare  cases  we 
find  that  diseases  of  the  female  organs  are  simulated  for  the 
purpose  of  blackmail  or  divorce,  and  it  is  not  uncommon  for 
women  to  introduce  irritating  substances  into  the  vagina,  thus 
giving  rise  to  leucorrhoea  ;  or  they  may  complain  of  pain  and 
difficulty  of  movement. 

Feigned  Hemorrhagic  and  Cutaneous  Conditions.— 

Hemoptysis  and  hematemesis  have  frequently  been  pretended, 
and  persons  have  swallowed  the  blood  of  animals,  which  they 
have  subsequently  ejected,  or  have  pricked  or  wounded  their 
gums  or  mouth,  so  that  a  proper  supply  of  blood  should  be 
provided. 

Cases  of  factitious  dysentery  are  common,  but  as  a  rule  tlv' 
character  of  the  stools  and  the  absence  of  mucus  will  throv/ 
light  upon  the  deception. 

The  ingenuity  shown  for  the  purpose  of  escaping  work 
is  great  indeed.  Not  only  do  we  find  that  by  the  appli- 
cation of  irritating  substances  the  skin  is  denuded  and 
ulcers  are  produced,  but  we  find  that  it  is  often  rubbed 
so   that   an    open    sore    is    created.     It  is.   not  uncomiuon   to 


2l6  MEDICAL    JURISPRUDENCE, 

I 

find  malingerers  producing  a  pseudo  small-pox  by  the  applica- 
tion of  Croton  oil  to  the  body,  but  it  hardly  need  be  said  that 
the  absence  of  umbilication  and  other  signs  of  the  true  disease 
show  its  artificial  production.  Sponges  saturated  with  dyes  or 
■with  blood  have  been  introduced  into  the  different  cavities  of 
the  body  to  give  the  idea  of  cancerous  tumors  or  hemorrhoids, 
and  the  books  contain  numerous  cases  where  the  guts  of 
animals  have  been  introduced  into  the  rectum  for  the  purpose 
of  producing  factitious  prolapsus. 

Feigned  Diseases  of  tlie  Eye. — Ophthalmia  is  artificially- 
produced  by  the  application  of  irritant  substances,  or  by  the 
removal  of  lashes  from  the  lids,  or  by  the  introduction  of 
sand. 

It  may  be  well  to  attend  to  those  who  sham  blindness.  Bella- 
donna may  be  placed  in  the  eye  to  produce  pupillary  changes, 
but  most  frequently  we  have  nothing  to  guide  us  but  the 
patient's  statement  and  behavior.  The  fraud  will  often  be 
explained  by  the  method  in  which  the  patient  holds  his  head, 
or  moves  about,  by  closure  of  the  eyes,  or  by  his  behavior  when 
suddenly  confronted  with  some  one  he  is  interested  in. 

In  some  instances  it  is  well  to  use  spectacles  in  one  side  of 
which  a  prism  is  fixed.  If  these  are  put  on  and  he  is  told  tu 
look  at  an  object,  of  course  the  image  will  be  doubled  by  the 
prism.  If  he  is  thrown  off  his  guard,  as  he  may  be  in  his 
willingness  to  admit  that  he  needs  help  in  the  way  of  glasses, 
he  may  admit,  as  one  impostor  did,  that  he  sees  two 
images,  which,  of  course,  will  prove  that  his  vision  is  unaffec- 
ted. If  he  admits  seeing  only  one  object  the  test  will  be  con- 
clusive that  he  is  dishonest. 

Boisseau  has  given  the  following  test  for  the  detection  of 
amaurosis  when  the  individual  has  both  eyes  open.  If  there 
be  a  double  image  produced,  when  pressure  on  the  angle  of  the 
pretended  amaurotic  eye  is  made,  we  may  rest  assured  that 
there  is  fraud. 

Feigned  Deafness. — Deafness  is  often  complained  of  by 
impostors.  Ogston  mentions  the  case  of  a  prisoner  suspected 
of  shamming  sudden  and  complete  deaf-mutism.  A  bunch  of 
keys  was  dropped  at  his  back  from  a  high  window,  while  he 
was  walking  in  the  prison  yard  without  any  notice  being  taken. 
When  the  same  thing  was  being  done  in  a  case  of  congenital 
deaf-mutism,  the  prisoner  started  in  alarm  and  looked  about  in 
all  directions  except  that  from  which  the  sound  came. 

For  the  purjjose  of  detecting  feigned  deafness  and  dumbness 


HYSTEROID    STATES    AND    FEIGNED    DISEASES.  217 

we  may  resort  either  to  chloroform  or  other  agents,  in  order  to 
disarm  the  patient  and  to  pervert  the  volitional  condition,  or 
we  may  produce  a  sudden  shock  upon  the  vocal  organs,  as  has 
been  suggested  by  a  writer  in  one  of  the  English  journals.  In 
this  case  a  strong  electric  shock  was  applied  over  the  larynx  of 
a  boy,  who  had  for  some  time  deceived  a  large  number  of 
people.  I  have  upon  several  occasions  resorted  to  this  means 
in  hysterical  girls,  and  in  one  case,  that  of  a  young  woman 
who  had  remained  silent  for  over  a  month  for  the  purpose  of 
escaping  her  duties  at  school  and  securing  a  trip  to  Europe,  I 
found  that  the  application  of  the  Faradic  current,  when  unex- 
pected, produced  an  instant  return  of  speech  and  a  vigorous 
remonstrance  from  the  pretender. 

Much  depends  upon  the  way  we  approach  malingerers  who 
feign  deafness  or  dumbness.  We  are  to  watch  their  facial  ex- 
pression, and  engage  their  attention  in  any  way  which  seems 
the  most  appropriate.  The  threat  of  an  operation,  or  some  pro- 
position which  materially  affects  the  interests  of  the  person  may 
cause  him  to  betray  himself.  In  a  recent  English  case  a 
prisoner  accused  of  murder  pretended  to  be  deprived  of  his 
hearing  and  speech,  and  his  pretended  infirmity  at  first  gained 
for  him  the  sympathy  of  every  one  in  the  court-room.  The 
man,  however,  refused  to  plead,  but  it  subsequently  transpired 
that  he  was  perfectly  cognizant  of  his  situation  and  the  course 
of  the  case,  and  he  was  finally  convicted.  Fodere  relates  the 
case  of  a  deserter,  who  was  condemned  to  labor,  and  pretended 
deafness,  that  he  might  escape  his  ordinary  duties.  Fodere, 
suspecting  the  imposture,  addressed  him  in  an  ordinary  tone, 
saying,  "  you  cannot  persuade  me  that  you  are  deaf,  but  if  you 
confess  the  truth,  you  shall  have  your  discharge."  The  man 
immediately  answered,  "  very  well,  I  am  not  deaf." 

Numerous  cases  of  pretended  deafness  are  to  be  found  in 
works  relating  to  military  subjects.  Mr.  Marshall  relates  the 
case  of  "  a  recruit  from  Cork,  who  joined  the  depot  of  the  East 
India  Company  at  Chatham.  He  alleged  that  he  had  almost 
totally  lost  the  sense  of  hearing,  and  the  testimony  of  his  com- 
rades from  Ireland  served  to  support  his  statement.  Dr.  Davis, 
sergeant  to  the  depot,  admitted  him  into  the  hospital,  and  put 
him  upon  spoon  diet.  For  nine  days  Dr.  Davis  passed  his  bed 
during  his  visit  to  the  hospital,  without  seeming  to  notice  him. 
On  the  tenth  day  he  felt  his  pulse,  and  made  signs  to  him  to 
put  out  his  tongue.  He  then  asked  the  hospital  sergeant  what 
diet  he  gave  the  man.  '  Spoon  diet,'  replied  the  sergeant.  The 
doctor  affected  to  be  displeased,  and  in  a  low  voice  said,  *  are 


2l8  MEDICAL   JURISPRUDENCE. 

you  not  ashamed  of  yourself  ?  The  poor  fellow  is  almost 
starved  to  death  ;  let  him  instantly  have  a  beefsteak  and  a  pint 
of  porter.'  The  recruit  could  contain  himself  no  longer.  With 
a  countenance  expressive  of  gladness  and  gratitude  he 
addressed  Dr.  Davis  by  saying,  '  God  Almighty  bless  your 
honor  ;  you're  the  best  gentleman  I  have  seen  for  many  a  day.'  " 

Self-inflicted  Wounds. — Self-inflicted  wounds  are  made 
for  various  purposes,  and  as  we  have  seen  in  the  Whittaker  case, 
such  wounds  may  be  inflicted  for  the  purpose  of  attracting 
sympathy,  and  for  cloaking  some  criminal  act  that  may  have 
been  committed. 

The  case  of  Bolam,  referred  to  by  Taylor,  who  was  tried  for 
the  murder  of  a  man  named  Milly,  is  one  of  great  interest. 
"Bolam  was  found  lying  in  an  apartment  which  had  been 
fired  by  himself,  or,  as  he  alleged,  by  some  incendiary,  and 
near  him  was  the  body  of  the  deceased,  who  had  evidently  been 
killed  by  violence,  the  skull  having  been  extensively  fractured 
by  a  poker  lying  near.  The  prisoner  when  found  was  either 
insensible,  or  he  pretended  to  be  so.  He  stated  that  he  had 
been  suddenly  attacked  by  a  man  and  knocked  down  by  a 
blow  on  the  right  temple  ;  for  attempting  to  escape  he  was 
again  knocked  down.  He  then  felt  a  knife  in  his  throat,  but 
admitted  that  he  did  not  put  up  his  hands  to  protect  it.  His 
hands  were  not  cut.  He  remembered  receiving  some  blows  on 
his  body  ;  then  he  became  insensible,  and  recollected  nothing 
more.  On  examining  his  throat  there  was  a  wound  an  inch  and 
a  half  in  length  on  the  left  side  of  the  neck,  a  quarter  of  an 
inch  below  the  jaw  ;  it  had  punctured  nearly  through  the  true 
skin,  and  was  of  inconsiderable  extent.  A  small  quantity  of 
blood  which  had  flowed  down  on  the  inside  of  his  cravat  had 
escaped  from  his  wound.  There  were  many  cuts  on  his  coat 
at  the  back  and  sides,  through  his  waistcoat,  shirt,  and  flannel 
sliirt,  but  there  were  no  corresponding  cuts  or  stabs,  nor  indeed 
any  mark  of  injury  upon  his  skin.  The  question  was,  whether 
these  wounds  were  inflicted  by  the  unknown  person  who  was 
alleged  to  have  fired  the  premises  and  murdered  the  deceased  ; 
or  whether  the  prisoner  had  inflicted  them  on  himself,  in  order 
to  divert  attention  and  conceal  the  crime  which  he  was  accused 
of  having  committed.  No  motive  for  the  imputed  crime  was 
discovered,  but  the  medical  facts  relative  to  the  self-infliction 
of  wounds  were  so  strong  that  he  was  convicted  of  man- 
slaughter. There  was  no  doubt  but  that  the  prisoner  had 
inflicted   the   wounds  upon   himself  in   order  to    remove  the 


HYSTEROID    STATES   AND    FEIGNED    DISEASES.  219 

suspicion  that  he  had  caused  the  death  of  the  deceased. 
They  were  superficial  and  involved  no  important  organs,  and 
bore  the  characteristics  whicli  those  only  would  have,  which 
had  not  been  produced  with  a  suicidal  intention." 

A  case  which  I  remember  is  that  of  a  bank  cashier,  who  was 
found  gagged  and  tied,  and  wounded  in  a  superficial  manner, 
while  the  funds  of  the  bank  were  missing.  It  subsequently 
transpired  that  the  wounds  were  self-inflicted,  and  other  pre- 
parations were  made  for  the  purpose  of  diverting  suspicion  and 
to  screen  him  from  the  imputation  of  the  theft,  for  which  he 
was  responsible. 

Sometimes  persons  who  seek  damages  for  alleged  injuries 
will  so  mutilate  themselves,  or  cut  their  clothing,  as  to  make 
their  cases  much  more  grave  than  they  really  are.  Mr. 
Scribner  has  told  me  of  a  case  of  this  kind,  where  it  had 
been  alleged  that  the  patient's  left  foot  had  been  injured 
by  the  wheel  of  a  car,  and  sure  enough  the  marks  of  a  slight 
injury  were  there  found.  It  occurred  to  the  counsel  for  the 
defense  to  call  for  the  shoe,  which  was  unthinkingly  produced 
by  the  other  side,  who  fell  into  the  trap,  and  it  was  found  that 
the  cut  shoe  belonged  to  the  other  foot ! 

Persons  who  have  unsuccessfully  attempted  to  commit 
suicide  occasionally  attribute  the  infliction  of  their  wounds 
to  another.  In  these  cases  the  incisions  are  usually  of  slight 
depth  and  evidently  made  by  the  person  himself,  for  they  are 
always  in  front  and,  as  a  rule,  made  by  the  right  hand.  Taylor 
calls  attention  to  the  fact  that  the  hands  are  seldom  wounded 
in  such  cases,  while  in  real  homicidal  attempts  we  find  that 
in  the  struggle  with  the  assailant  the  hands  are  usually  slashed 
and  cut. 

In  fraudulent  cases,  where  violence  is  imputed  to  other 
persons,  excoriations  and  even  skin  lesions  are  alleged  to  be  th*e 
result  of  violence,  we  must  be  very  careful  to  see  whether 
the  cuts  or  rents  in  the  cloth  correspond  with  the  actual 
wounds,  for  impostors  are  very  apt  to  produce  holes  or  rents 
in  their  clothing  when  removed  from  the  body.  A  case  is 
related  where  a  young  man  had  unconsciously  furnished  evi- 
dence against  himself.  He  had  charged  a  man  with  unlawfully 
wounding  him  on  the  highway,  and  stated  that  the  man  had 
stabbed  him  on  the  arm,  cutting  through  his  shirt  and  coat 
sleeve  ;  but  on  examining  the  coat  it  was  found  that  the  cut 
was  confined  to  the  cloth  itself,  and  did  not  extend  through 
the  lining  ;  besides  this,  there  was  no  motive  for  the  crime. 

Tidy  refers  to  the  case  reported  by  Marc  of  a  man  who  had 


2  20  MEDICAL   JURISPRUDENCE. 

an  "  idea  of  rendering  himself  so  important  to  a  relative  as  to 
secure  his  gratitude,  and  pretended  to  have  had  a  murderous 
conflict  with  some  assassins,  although  no  dead  bodies  could  be 
found.  His  head  was  wounded  longitudinally  to  the  extent  of 
about  one  inch,  and  in  direction  from  left  to  right.  Only  the 
integuments  were  divided.  His  hat  of  soft  velvet  was  cut  off 
for  nearly  three  inches,  and  in  a  direction  from  right  to  left.  A 
cotton  bonnet  and  a  silk  handkerchief  which  he  wore  under  his 
hat  were  also  divided.  '  So  powerful  a  blow  as  to  divide  all 
these,'  says  Dr.  Marc,  '  should  have  inflicted  a  less  superficial 
lesion  on  the  head.'  Theknifeused  by  him  in  killing  the  assassin 
had  a  thick  covering  of  blood,  as  if  daubed  on.  Had  he  really 
used  it  to  stab  through  clothes  and  flesh,  he  would  have  rubbed 
off  some  of  the  blood  in  withdrawing  it,  and  what  remained 
would  be  in  longitudinal  strise." 

Dr.  Marc  deemed  the  whole   case  pretended,   the  effect  not 
corresponding  with  the  force  of  the  ascribed  cause. 


CHAPTER  IV. 

EPILEPSY. 

We  are  called  upon  from  time  to  time  to  examine  patients 
who  present  epilepsy  as  a  result  of  injury  ;  or  whose  mental  con- 
dition is  such  as  to  lead  them  to  commit  crimes  ;  or  again  we 
are  required  to  give  opinions  upon  the  capacity  of  epileptics 
who  make  civil  contracts. 

Traumatic  Epilepsy. — In  the  matter  of  traumatic  epilepsy 
it  behooves  us  to  distinguish  between  paroxysmal  attacks,  which 
originate  from  other  causes  than  those  which  are  alleged  to  have 
existed,  and  the  purely  traumatic  variety.  The  question  may  arise 
in  such  cases  whether  or  not  there  has  been  idiopathic  disease 
of  long  standing,  which  is  connected  by  a  dishonest  patient  with 
the  accident  and  may  be  made  the  basis  of  litigation  ;  or 
whether  an  incomplete  form  of  the  disease  may  be  developed 
by  a  shock  or  head  injury.  We  are  to  determine  as  well,  just 
how  much  the  neurotic  taint  of  the  individual  may  have,  to  do 
with  his  aggravated  condition.  Traumatic  epilepsy,  as  a  rule, 
is  apt  to  be  manifested  by  some  dominant  form  of  localized 
convulsion  which  is  more  or  less  constant,  and  this  is  especi- 
ally the  case  if  there  be  evidences  of  injury  of  the  vertex. 

Cortical  Epilepsy. — Depression  of  bone  on  the  parietal 
region  is  quite  commonly  attended  by  hemi-epilepsy,  beginning 
in  one  of  the  motor  centers  receiving  its  supply  from  the  par- 
ticular cortical  center  involved.  There  is  a  great  irregularity 
about  this  form  of  disorder,  and  rarely  the  periodicity  found 
in  the  idiopathic  variety.  The  attacks  are  more  readily  pre- 
cipitated by  exciting  causes  which  favor  determination  of  blood 
to  the  head  than  those  of  the  other  varieties.  There  may  or 
may  not  be  symptoms  of  meningeal  inflammation,  but  as  a  rule 
sooner  or  later  we  find  the  indications  of  such  a  condition. 
The  comparatively  rapid  development  of  symptoms  suggestive 
of  coarse  cerebral  disease  is  to  be  looked  for.  In  an  individual 
who  had  plunged  headforemost  into  an  elevator  shaft,  striking 
his  head  upon  the  stone  flooring  ten  feet  below,  I  found  besides 


222  MEDICAL   JURISPRUDENCE. 

violent  epilepsy  the  signs  of  rapid  degeneration  of  the  brain 
mass.  In  a  few  months  he  complained  of  mental  weakness,  loss 
of  memory,  and  great  headache  as  well  as  double  optic  neu- 
ritis. 

The  complication  of  pain  in  such  cases  is  quite  common,  and 
this  pain  is  severe,  dull  and  throbbing.  Traumatic  epilepsy,  I 
think,  is  often  expressed  by /<?///  mal,  but  the  violent  attacks 
are  those  most  commonly  found. 

Head  Injury  in  Epilepsy. — The  head  injury  giving 
rise  to  the  disease  need  not  leave  behind  any  conspicuous 
marks,  although  we  find  as  a  rule  some  scar  or  depression. 
Nothnagel  *  presents  the  case  of  a  boy  who  fell  a  distance  of 
twelve  feet  upon  his  head.  He  was  unconscious  for  fifteen 
minutes,  and  after  being  roused  was  seized  with  an  attack  of 
convulsions.  His  only  wound  was  a  small  one  of  the  scalp, 
which  rapidly  healed,  and  for  six  weeks  subsequently  he  appear- 
ed to  be  in  perfect  health.  He  then  had  a  second  seizAire,  fol- 
lowed by  others,  and  has  since  had  frequent  paroxysms,  which 
succeed  each  other  very  closely,  being  separated  by  intervals  of 
only  ten  or  twelve  days.  These  are  preceded  by  an  aura  and 
begin  by  a  turning  of  the  head  to  the  left.  Between  the  attacks 
the  patient  has  headaches  and  slight  twitchings  in  the  left  half 
of  the  face  or  upper  arm.  The  accident  occurred  when  he  was 
eight  years  old,  and  when  reported  he  was  twenty-one. 

His  mental  condition  was  one  of  failure,  and  his  memory 
was  weak.  The  only  evidence  of  the  injury  was  a  small  cica- 
trix, "about  the  size  of  a  lentil,  corresponding  to  the  right  cor- 
onal suture,  and  four  centimeters  distant  from  the  median  line. 
This  is  not  painful  or  adherent,  and  when  touched  either  gently 
or  quite  roughly  no  symptoms  are  manifested." 

This  example  is  one  illustrating  the  connection  of  local  head 
injury  with  an  undoubted  lesion  of  a  cortical  center,  and  if  it 
had  been  a  contested  case  no  doubt  could  have  arisen  as  to  the 
causation  of  the  disease. 

Reflex  Epilepsy. — Experimental  physiology  and  pathology 
have  shown  that  irritation  or  injury  of  distant  parts  have  given 
rise  to  epilepsy.  Wounds  of  peripheral  nerves  have  caused 
the  so-called  "reflex  epilepsy."  Injuries  of  the  sciatic  or  tri- 
geminal nerves  are  more  apt  to  give  this  result  than  any  others, 
and  sometimes  when  a  wound  has  been  made,  the  cicatricial  con- 
traction, such  as  was  found  in  the  cases  of  Lente  and  Schnee, 

*  Ziemssen's  Encyclopedia,  vol.  xiv.  p.  208,  Am.  Translation. 


EPILEPSY.  223 

may  be  the  focus  of  irritation.  Such  epilepsies  are  manifested 
by  a  sensory  aura  originating  in  the  cicatrix,  and  the  motor 
disorders  are  local  or  general.  In  nearly  every  case  of  this 
kind  the  paroxysms  do  not  occur  until  some  time  after  the  in- 
jury. We  should  be  very  careful  in  these  forms  of  epilepsy  to 
give  a  guarded  opinion  as  to  the  prognosis,  for  an  operation 
may  relieve  the  condition. 

The  prognosis  of  the  ordinary  form  of  epilepsy  is  bad,  and 
especially  is  this  true  of  the  idiopathic  disease.  A  history  of 
hereditary  influence  is  a  most  important  one.  Traumatic  epi- 
lepsy has  a  more  favorable  prognosis,  for  the  chance  of  relief 
by  an  operation  is  by  no  means  a  poor  one.  In  the  light  of 
the  modern  advances  in  our  knowledge  of  cerebral  anatomy 
and  physiology  the  use  of  the  trephine  is  more  often  followed 
by  good  results  if  sagaciously  applied. 

Mental  Condition  of  Epileptics. — The  mental  condition 
of  epileptics  is  most  interesting  :  it  is  often  difficult  to  de- 
termine capacity,  and  there  can  be  no  doubt  that  there  are 
many  cases  of  doubtful  responsibility  that  may  be  explained 
by  a  history  of  epilepsy. 

The  many  peculiar  mental  states  that  occur  in  connection 
with  this  disease  are  worthy  of  the  closest  study.  Epilepsy, 
after  all,  is  a  symptomatic  condition  itself,  and  one  of  import- 
ance. Of  late  many  curious  forms  of  temporc.ry  mental  aber- 
ration have  been  spoken  of  as  epileptoid,  and  it  will  at  once 
be  seen  that  in  determining  the  capacity  of  an  individual, 
either  in  civil  or  criminal  cases,  it  may  be  necessary  to  deter- 
mine the  existence  and  influence  of  the  epileptoid  state.  So 
important  is  the  influence  of  the  disease  that  Lutaud  says : 
"  Tout  epileptique  sans  etre  un  aliene  est  un  volontier  candidat 
de  la  folic." 

We  are  to  determine  in  cases  submitted  to  us  : 

1.  The  influence  of  the  epileptic  state. 

2.  The  post  paroxysmal  mental  state. 

3.  The  irregular  or  aborted  epileptic  state. 

The  mental  condition  of  certain  epileptics,  when  the  disease 
begins  early  in  life,  or  is  congenital,  is  one  approximating  imbe- 
cility. The  same  may  be  said  to  be  the  case  when  the  disease 
has  lasted  for  some  years,  and  it  is  admitted  by  neurologists 
that  the  lesser  attacks  {petit  nial)  predispose  more  to  mental 
degeneration  than  those  more  severe  (grand  mal).  The  victim 
of  epilepsy  as  a  result  of  infantile  brain  disease  often  presents 
one-sided  paralysis  with  dwarfed  limbs,  and  this  may  prove  to 


224  MEDICAL  JURISPRUDENCE. 

be  a  valuable  indication  so  far  as  the  duration  of  the  malady  is 
concerned. 

The  epiletic  is  very  apt  to  present,  sooner  or  later,  some  men- 
tal infirmity  in  connection  with  the  paroxysms.  Of  339  cases 
of  epileptic  insanity,  collected  by  Esquirol,  145  were  dements, 
176  suffered  from  mania  which  was  partial,  sub-acute  or  violent, 
8  were  idiots,  and  all  but  60  manifested  loss  of  memory. 

The  Post-Paroxysmal  Condition. — The  post-paroxys- 
mal states  are  those  which  frequently  form  the  basis  of  homi- 
cidal acts,  a  species  of  ill-defined  and  temporary  mania  result- 
ing ;  at  other  times  the  patient  may  be  peaceable  and  quiet. 

The  third  class  of  cases  includes  those  in  which  at  periods 
the  man  may,  without  any  warning  and  while  there  is  no  par- 
oxysm, do  some  violent  act  which  he  knows  nothing  about 
afterwards.  I  have  a  patient  under  my  care  who  occasionally 
loses  her  consciousness  and,  though  she  does  not  fall  to  the 
ground  or  show  any  spasmodic  action  at  all,  will  occasionally 
strike  those  about  her  and  call  them  foul  names.  She  has  been 
known  to  leave  her  house  and  walk  several  blocks,  and  to  sud- 
denly recover  her  senses  in  a  shop.  There  are  undoubtedly  many 
cases  in  which  crimes  are  committed  under  such  circumstances 
as  these,  a  murderer  for  instance  being  entirely  unconscious  of 
his  crime  until  after  it  is  committed.  A  patient  under  treat- 
ment some  years  ago  was  a  peaceable,  quiet  man  ;  he  was  a  de- 
voted husband  and  father.  He  had  suffered  from  epilepsy  for  sev- 
eral years,  and  had  both  well  marked  attacks  of  grand  mal  and 
in  addition  seizures  of  an  incomplete  character.  While  at  the 
table  one  day  he  suddenly  changed  color,  and  made  a  violent 
demonstration  towards  his  wife,  who  rushed  from  him  through 
the  open  door  and  down  into  the  street.  He  followed  immedi- 
ately behind  her,  and  holding  a  pistol  against  her  body  dis- 
charged it,  killing  her  instantly.  He  recovered  almost  at  once 
and  was  stricken  with  horror  to  find  his  clothes  covered 
with  blood,  and  his  dead  wife  lying  at  his  feet.  No  attention 
was  paid  to  the  evidence  given  in  court  as  to  his  disease,  and 
he  was  sentenced  to  imprisonment  for  life.  His  epilepsy  has 
increased  since  his  incarceration. 

Clymer  npon  Responsibility. — In  an  admirable  paper 
Dr.  Meredith  Clymer*  traces  the  mental  condition  of  the  epi- 
leptic as  follows: — "In  most  instances,"  he   says,  "  an   uneasy 

♦Medico-Legal  Reports,  vol.  I,  p.  446. 


EPILEPSY.  225 

depressed  and  irritable  state  of  tlie  mind,  immediately  precedes 
an  attack,  and  there  is  constantly  some  disturbance  of  the 
affective  and  intellectual  faculties  manifest  directly  after  it, 
which  may  persist  during  a  large  part  or  the  whole  of  the  inter- 
val between  the  fits.  The  affective  faculties  chiefly  suffer.  The 
disposition  is  apt  to  be  moody,  suspicious,  wayward,  spiteful 
and  wrathful.  Offense  is  readily  taken  ;  there  is  a  fancy  to 
tease  and  annoy  and  be  troublesome,  and  a  dread  of  insult  and 
injury.  The  moral  qualities  are  perverted,  and  the  sense  of 
propriety,  decency  or  duty  is  obscured  or  lost. 

"  The  physical  derangements  to  which  the  epileptic  is  liable 
are  exhibited  under  various  expressions.  In  many  cases  there 
is  gradual  failure  of  intelligence  ending  in  total  mental  annihila- 
tion, others  show  anomalies  of  character  and  disposition  which 
hardly  go  beyond  harmless  eccentricities  of  conduct,  or  at  most 
involve  a  change  of  temper  and  habits.  In  some  there  may 
be  an  extreme  perversion  of  affective  life,  and  occasional  ex- 
plosion of  automatic  temper  fits,  in  which  he  loses  his  knowl- 
edge of  himself,  but  is  generally  content  to  unpack  his  mind 
in  words,  ' — tantum  maledicit  utrique,  vocando.  Hanc,  furiam  ; 
hunc,  aliud,  jussit  quod  splendida  bilis,'  or  there  maybe  those 
terrible  outbursts  of  maniacal  fury  accompanied  by  homicidal 
or  suicidal  impulses  or  both." 

The  Character  of  Congenital  Epileptics. — The  varie- 
ty of  epileptic  states  when  the  disease  is  not  suspected  is  a  great 
one.  Maudsley*  thus  refers  to  the  genesis  of  the  state,  analyz- 
ing the  mental  condition  of  children  : 

"  In  children,  as  in  adults,  a  brief  attack  of  violent  mania, 
a  genuine  mania  transitoria,  may  precede  or  follow,  or  take  the 
place  of  an  epileptic  fit ;  in  the  latter  case,  being  a  case  of 
masked  epilepsy.  Children  of  three  or  four  years  of  age  are 
sometimes  seized  with  attacks  of  violent  shrieking,  desperate 
stubbornness,  or  furious  rage,  when  they  bite,  tear,  kick  and  do 
all  the  destruction  they  can  ;  these  seizures,  which  are  a  sort 
of  vicarious  epilepsy,  come  on  periodically,  and  may  either 
pass  in  the  course  of  a  few  months  into  regular  epilepsy,  or 
may  alternate  with  it.  Older  children  have  perpetrated  crimes 
of  a  savage  and  determined  nature — incendiarism,  and  even 
murder — under  the  influence  of  similar  attacks  of  transitory 
fury,  followed  or  not  by  epileptic  convulsions.  It  is  of  the 
utmost  importance  to  realize  the  deep  effect  which  the  epilep- 

*  London  Lancet,  July,  1S70,  p.  646. 

IS 


226  MEDICAL   JURISPRUDENCE. 

tic  neurosis  may  have  on  the  moral  character,  and  to  keep  in 
mind  the  possibility  of  its  existence  when  a  savage,  apparently 
motiveless  and  unaccountable  crime  has  been  committed.  A 
single  epileptic  seizure  has  been  known  to  change  entirely  the 
moral  character,  rendering  a  child  rude,  vicious  and  perverse, 
who  was  hitherto  gentle,  amiable  and  tractable.  No  one  who 
has  seen  it  can  fail  to  have  been  struck  with  the  great  and 
abrupt  change  in  the  moral  character  which  takes  place  in  the 
asylum  epileptic  immediately  before  the  recurrence  of  his  fits  ; 
in  the  intervals  between  them  he  is  often  an  amiable,  obliging, 
and  industrious  being,  but  when  they  impend  he  becomes  sul- 
len, morose,  and  most  dangerous  to  meddle  with.  Not  an 
attendant  but  can  then  foretell  that  he  is  going  to  have  his  fits, 
as  confidently  almost  as  he  can  foretell  that  the  sun  will  rise 
next  day.  Morel  Has  made  the  interesting  observation,  which 
is  certainly  well  founded,  tliat  the  epileptic  neurosis  may  exist 
for  a  considerable  period  in  an  undeveloped  or  masked  form, 
showing  itself,  not  by  convulsions,  but  by  periodic  attacks  of 
mania  or  by  manifestations  of  extreme  moral  perversion,  which 
are  apt  to  be  thought  willful  viciousness.  But  they  are  not ; 
no  moral  influence  will  touch  them;  they  depend  upon  a  mor- 
bid physical  condition,  which  can  only  have  a  physical  cure  ; 
and  they  get  their  explanation,  and  indeed,  justification,  after- 
wards, when  actual  epilepsy  occurs." 

Hiigliliiigs  Jackson  on  Epilepsy. — There  are  light  epi- 
leptic seizures  considered  by  Hughlings  Jackson,  which  are  ex- 
pressed by  the  performance  of  subsequent  automatic  acts,  and 
these  are  worthy  of  the  closest  study  because  of  their  medico- 
legal interest.  Jackson  considers  four  classes  of  cases.  First 
— Those  in  which  eccentric  or  grotesque  acts  alone  are  mani- 
fested. Second — Those  in  which  marked  complexity  of  action 
directly  complicated  the  epileptic  attacks.  Third — Those  that 
might  have  a  bearing  in  civil  actions,  but  without  criminal  im- 
portance ;  and  a  fourth  set  of  cases  which  are  manifested  by 
violent  acts,  which  give  rise  to  the  question  of  criminal  re- 
sponsibility. Among  the  first  group  occur  those  cases  of  de- 
cided absent-mindedness  which  lead  the  individual  to  do  ab- 
surd things.  Jackson  relates  the  case  of  an  epileptic  who, 
when  in  an  omnibus,  blew  his  nose  on  a  piece  of  paper  and 
when  he  left  the  stage  gave  the  conductor  ;^2  ice.  instead  of  the 
twoi)ence-halfpenny  which  constituted  the  regular  fare.  This 
man  was  an  epileptic  and  lie  probably  had  a  slight  attack  o'i peiit 
vial  immediately  before  the  occurrence.    I  have  at  present  under 


EPILEPSY.  227 

charge  a  patient  who  has  frequent  attacks  of  petit  inal,  and 
sometimes  at  the  table  rubs  her  hair  with  her  bread,  and  does  a 
variety  of  eccentric  things  which  are  often  preceded  by  a  well- 
recognized  facial  spasm  or  change  in  color,  but  more  often  not. 

The  second  class  of  cases  includes  individuals  who 
perform  unconsciously  a  number  of  elaborate  and  compound 
actions.  During  the  attack  itself  the  individual  may  go  through 
with  a  variety  of  unconscious  performances  for  which  he  should 
not  be  held  responsible  and  the  nature  of  these  depends  very 
much  upon  the  disposition  and  education  of  the  person.  I  have  a 
patient  who  when  seized  will  immediately  barricade  the  doors 
of  the  room  in  which  he  may  be  and  upon  the  entrance  of  a 
member  of  the  family,  whom  he  evidently  does  not  know,  will 
advance  in  a  threatening  manner,  and,  if  not  held,  commits 
a  violent  assault  ;  after  the  return  to  consciousness  the  pa- 
tient will  have  no  recollection  of  the  attack,  and  upon  the  oc- 
casion when  the  doors  were  barricaded  he  expressed  great  sur- 
prise at  seeing  the  chairs  piled  one  upon  another. 

Jackson  relates  the  case  of  a  man  who  detailed  the  features 
of  one  of  his  seizures  as  follows  : 

He  says  :  "  I  felt  symptoms  of  an  attack,  and  sat  down,  I 
believe,  on  a  chair  against  the  wall.  And  here  my  recollection 
failed  ;  the  next  thing  I  was  conscious  of  being  in  the  pres- 
ence of  my  brother  and  mother  (who  had  been  sent  for,  as 
they  lived  opposite)  ;  and  I  have  since  been  informed  by  my 
sister-in-law  that  she  came  into  the  kitchen  and  found  me 
standing  by  the  table  mixing  cocoa  in  a  dirty  gallipot,  half  filled 
with  bread  and  milk,  intended  for  ihe  cat,  and  stirring  the  mix- 
ture with  a  mustard-spoon,  tti/iich  I  must  have  gone  to  the  cup- 
board to  obtain^ 

Lighter  Grades  of  Epilepsy. — in  these  seizures  the  fact 
appears  that  the  more  light  is  the  fit  the  more  complex  is  the  au- 
tomatic state,  and  it  can  not  be  disputed  that  many  so-called 
criminal  actions  are  the  result  of  trifling  masked  attacks  which 
were  entirely  unrecognized.  Jackson  saw  a  boy,  a  boot-black, 
who  once  after  a  seizure  threw  his  blacking-box  at  a  police- 
man and  was  arrested  and  fined  ;  and  upon  another  occasion 
he  got  into  a  violent  altercation  with  a  gentleman  in  the  street, 
who,  according  to  his  story,  had  offered  him  five  shillings  to 
clean  his  boots.  This  boy  ultimately  became  an  inmate  of  an 
insane  asylum. 

Testamentary  Capacity  and  Epilepsy. — The  wills  of 
epileptics  are  sometimes  contested.     There  are  few  cases,  how- 


2  28  MEDICAL   JURISPRUDENCE. 

ever,  where  sufficient  attention  is  paid  to  the  inter-paroxysmal 
state — which  after  all  is  the  important  question  to  consider.  I 
append  two  American  cases  where  the  wills  of  epileptic  per- 
sons were  sustained. 


Case  XLIX. — Will  Made  Between  Two  Epileptic  Attacks. 
Condition  of  Testator's  Mind  not  Necessarily  Un- 
sound.    Will  Admitted. 

Matter  of  Ross,  >•      12  N.  Y.  Weekly  Digest,  34. 


On  April  29th,  1879,  the  testator,  whq  had  been  subject  to 
attacks  ot  acute  mania,  superinduced  by  epileptic  convulsions., 
was  committed  to  a  hmatic  asylum.  He  was  discharged  May 
12,  1879.  The  Superintendent  of  the  asylum  testified  that  tes- 
tator's mental  condition  was  then  good  and  that  between  the 
epileptic  attacks  he  was  of  sufficient  mental  soundness  to  under- 
stand what  he  was  doing.  On  May  21,  1S79,  testator  executed 
his  will.  His  family  physician  testified  that  he  was  then  of 
sound  mind  and  memory  and  capable  of  making  a  will.  Tes- 
tator was  again  attacked  with  an  epileptic  convulsion  on  June 
II,  1879,  and  died  June  24th,  1879. 

Held,  that  testator  was  sane  at  the  time  the  will  was  made. 


Case  L. — Epilepsy  Complicated  by  Pneumonia.  Codi- 
cils Made  while  Suffering  from  Alleged  Delirium. 
Will  not  Sustained,  but  Finding  Afterwards  Re- 
versed.    No  Evidence  of  Impaired  Capacity. 


94  Illinois  R.,  560 

Elizabeth  M.  Riggin  was  on  Nov.  14,  1868,  at  the  age  of 
62,  attacked  with  an  epileptic  fit,  and  rendered  uncon- 
scious ;  an  attack  of  pneumonia  supervened  the  epileptic  fit 
accompanied  with  high  fever  and  occasional  delirium,  during 
which  she  would  be  unconscious.  Previous  to  her  illness  she 
was  intelligent  and  cultivated,  robust  and  strong,  though  ner- 
vous. She  was  regarded  as  a  gifted  and  brilliant  woman. 
Witnesses  on  both  sides,  who  were  present  during  her  illness, 
stated  that  while  occasionally  out  of  her  mind,  at  other  times 


EPILEPSY.  229 

she  was  rational  and  intelligent,  her  mental  condition  being 
clearly  the  result  of  delirium  attendant  on  high  fever.  No 
witness  claimed  that  she  had  wholly  lost  her  reason  at  that  pe- 
riod. On  Nov.  23,  1868,  she  executed  her  will.  Between  that 
time  and  her  death,  which  occurred  in  July,  1875,  she  executed 
three  codicils.  Each  of  the  witnesses  to  the  will  and  codicils 
testified  to  the  sanity  and  intelligence  of  deceased  at  the  time 
of  executing  them.  On  the  trial  of  the  issues  in  the  Circuit 
Court  of  St.  Clair  County  in  April,  1877,  before  a  jury,  it  was 
found  that  the  will  and  codicils  were  not  those  of  the  testator, 
Elizabeth  M.  Riggin.  That  is  to  say,  that  she  was  insane  at 
the  time  she  executed  them  and  they  were  therefore  null  and 
void.  On  appeal  to  the  Supreme  Court  of  Illinois  this  finding 
was  reversed. 

The  responsibility  of  epileptics  who  commit  offenses  against 
the  laws,  should  be  determined  by  careful  inquiry  into  their  pre- 
vious life,  the  existence  of  disease  and  the  nature  of  the  crime. 

The  discovery  that  the  patient's  progenitors  have  been  insane, 
that  if  she  be  a  woman  she  has  suffered  from  migraine  pre- 
viously, or  from  menstrual  difficulties,  will,  perhaps,  supply  a  clew 
to  follow  up.  There  may  be  a  history  of  "fainting  attacks," 
that  if  closely  investigated,  will  be  found  to  have  been  of  an 
epileptic  nature,  and  some  one  may  remember  a  head  injury  or 
an  attack  of  sunstroke. 

Le  Grand  du  Saulle  suggests  the  following  medico-legal  appli- 
cations in  relation  to  epilepsy  : 

When  the  character  and  habits  of  the  patient  are  full  of 
strange  anomalies,  and  there  are  startling  and  sudden  impulses, 
the  responsibility  should  be  questioned. 

The  patient  who  has  clearly  committed  an  attempt  when  not 
suffering  from  an  attack,  is  partially  responsible,  but  he  has 
the  right,  after  examination  into  his  mental  state,  to  an  exten- 
uation of  the  penalty,  and  in  some  way  proportionate  to  the 
degree  of  moral  resistance  which  can  be  opposed. 

A  motiveless  crime,  committed  under  the  immediate  influ- 
ence of  an  epileptic  paroxysm,  is  evidence  of  absolute  irrespon- 
sibility. 

When  the  crime  committed  by  the  epileptic  is  deliberate,  and 
bears  upon  its  face  its  explanation,  the  author  is  irresponsible. 

When  a  crime  is  not  to  be  accounted  for,  and  completely  in- 
consistent with  the  antecedents  of  one  who  is  not  known  to  be 
epileptic  or  insane,  and  when  it  is  accomplished  in  a  moment 
of  fury,  then  we  should  examine  whether  there  are  aborted  or 
nocturnal  attacks  of  epileosv. 


230  MEDICAL    JURISPRUDENCE, 

Incomplete  attacks  of  epilepsy,  or  epileptic  vertigo,  should 
be  suggestive  facts  in  determining  the  intellectual,  moral  or 
affective  standing  of  the  individual. 

"  Georget  not  only  commends  these  verdicts  of  acquittal, 
but,  also  recommends  that  for  acis  committed  in  the  intervals 
of  calm,  the  epileptic  should  be  punished  less  severely  than 
ordinary  criminals. 

"  This  opinion  has  been  again  concurred  in  by  M.  Bottex,  in 
reference  to  two  patients — one  of  a  naturally  mild  temper,  who 
put  to  death  in  a  paroxysm  of-  fury,  a  woman  who  made  certain 
representations  to  him  ;  and  another,  constantly  dull  and  stupid, 
who  was  offended  by  the  coquettish  dress  of  a  young  girl  of 
fifteen,  and  stretched  her  dead  at  his  feet  with  a  blow  of  a 
goyarde.  The  latter,  freed  without  trial,  was  placed  in  an  asy- 
lum as  a  measure  of  public  security"  (de  Boismont). 

In  some  cases  of  epileptic  insanity  there  is  a  state  of  mental 
disturbance,  after  the  attack,  when  the  patient  becomes  the 
subject  of  religious  delusions. 

Of  fifty  cases  reported  by  Addison,  thirteen  patients  were 
always  irritable  and  vicious  ;  thirteen  were  vicious  only  before 
the  fit  and  twenty-six  after  the  fit,  and  in  four  there  was  no 
mental  change. 

In  epileptic  insanity  we  should  look  out  for  the  signs  of 
previous  attacks,  such  as  scalp-wounds,  burns,  and  other  evi- 
dence of  injuries  that  may  have  been  received  during  a  parox- 
ysm. The  occurrence  of  limited  spasms,  vertiginous  attacks, 
paralyses,  the  history  of  syphilis,  and  the  question  of  heredity 
should  be  considered  as  well. 

In  many  cases  the  epileptic  paroxysm  is  always  attended 
with  homicidal  attempts,  and  the  patient  may  appeal  to  by- 
standers to  take  charge  of  him  when  he  has  an  aura.  Such  a 
case  was  reported  by  Marc,  the  patient  being  a  peasant,  aged 
twenty-seven,  who  had  epilepsy  for  nineteen  years.  When  he 
felt  a  warning  he  would  ask  for  protection,  saying  :  "  When  the 
feeling  comes  over  me  I  must  kill  some  one,  if  only  a  child." 

Maniacal  rage  of  short  duration  is  often  epileptic  in  charac- 
ter, and  its  true  character  is  often  mistaken. 

The  cases  of  epileptic  insanity  witli  homicidal  tendencies  are 
numerous.  The  following  is  one  of  a  common  type,  and  was 
reported  by  Dr.  Gray  : 

"  Man,  single,  aged  eighteen,  reads  and  writes,  smokes,  tem- 
perate, native  New  York,  not  hereditary.  Was  subject  to  at- 
tacks of  epilepsy  from  the  age  of  twelve  years.  The  fits  varied 
in  frequency  from  one  a  month  to  several  daily,  and  their  dura- 


EPILEPSY.  231 

tion  from  five  to  fifteen  minutes.  After  the  occurrence  of  the 
disease  he  made  little  progress  in  his  studies.  There  was  also 
a  marked  change  in  his  character,  he  lost  self-control,  had  pe- 
riods of  excitement,  and  was  at  times  ugly,  was  emotional 
and  governed  by  his  passions.  He  had  been  sent  on  two  occa- 
sions to  a  hospital  for  treatment  without  any  benefit.  His  father 
was  a  carpenter,  and  though  he  was  not  capable  of  learning  the 
trade  he  acquired  some  manual  skill,  and  occasionally  did  work 
for  a  widow  who  kept  a  variety  store  near  his  residence.  He 
was  fixing  some  shelving  for  her,  when  about  mid  day  she  was 
found  murdered  in  her  store  ;  her  body  was  much  mangled  by 
having  been  cut  with  a  hatchet.  Search  was  made  and  the  pa- 
tient was  arrested  as  he  was  walking  the  street,  his  hands  and 
clothes  stained  with  blood.  His  epileptic  and  irresj^jonsible 
condition  was  proved,  and  he  was  sent  to  the  asylum  by  order 
of  the  Court.  He  remained  some  twenty  months,  and  during 
this  time  improved  materially.  His  seizures  were  infrequent, 
and  he  gained  in  mental  strength.  At  this  time  he  eloped  from 
the  asylum  through  the  connivance  of  his  friends  and  enlisted 
in  the  army." 

Insane  impulses  may  exist  in  insane  epileptic  patients  and 
not  be  directly  connected  with  the  paroxysms.  A  patient  at 
the  Utica  Asylum  had  the  following  history  : 

"  Man,  aged  twenty-five,  uneducated  and  vicious.  Had  epi- 
lepsy induced  by  intemperance.  Became  quarrelsome,  consid- 
ered himself  injured,  and  in  a  rage  would  attempt  to  stab  those 
whom  he  disliked.  At  time  of  admission  to  the  asylum  exhib- 
ited no  marked  mental  aberration.  Soon  began  to  become  dement- 
ed ;  was  always  a  dangerous  man  ;  invariably  made  his  attacks 
in  the  day  time  and  on  persons  whom  he  disliked,  and  never 
threatened  or  used  violent  language.  The  homicidal  tendency 
was  not  constant,  but  at  times  attended  with  strong  suicidal 
disposition,  Avhich  occurred  independently,  so  far  as  could  be 
observed,  of  his  epileptic  seizures.  He  was  discharged  after 
some  years,  demented  and  harmless." 

Realization  of  Crime  by  the  Epileptic. — The  epileptic 
often  realizes  the  terrible  nature  of  his  impulses  and  begs  for 
protection  ;  and  in  his  sane  state  realizes  with  redoubled  force 
the  horrible  character  of  what  he  has  done  and  what  he  may 
do.  He  is  also  tortured  with  the  knowledge  that  his  mental 
perversion  will  not  .be  appreciated  by  others.  He  may  suffer 
from  ordinary  epileptic  attacks  wivch  are  not  connected  with 
any  homicidal  tendencies,  but   finally,  under  the  influence  of 


232  MEDICAL    JURISPRUDENCE. 

perhaps  an  epileptic  hallucination,  may  commit  some  act 
of  violence  which  to  the  layman  has  apparently  nothing  to  do 
with  his  previous  trouble. 

Nocturnal  Epilepsy. — The  epileptic  may  give  no  indica- 
tion of  his  real  condition,  the  attacks  perhaps  being  entirely 
nocturnal,  and  he  as  well  as  others  may  be  in  total  ignorance 
of  the  existence  of  the  disease.  If  such  a  person  commits  a 
crime  it  is  hardly  necessary  to  say  that  its  connection  with  epi- 
lepsy will  be  disregarded  unless  the  character  of  the  violent 
act  be  in  itself  suspicious.  Upon  careful  inquiry  it  may  be 
found  that  the  individual  has  had  unconscious  passages  of  urine 
in  his  bed  or  his  pillow  may  have  been  found  stained  with 
blood.  An  examination  may  reveal  cicatrices  suggestive  of 
tongue  biting — in  fact  there  may  be  every  reason  to  believe 
that  he  has  had  well  marked  epileptic  attacks  occurring  during 
the  night.  Clymer  refers  to  the  cases  reported  by  Dumenil 
and  Morel  ;  the  first  of  a  soldier  who  struck  his  superior  offi- 
cer and  who  was  subject  to  sudden  fits  of  passion  upon  slight 
provocation,  and  it  transpired,  from  the  statements  of  those 
who  slept  with  him,  that  he  had  had  epileptic  attacks  at  night 
for  several  years.  In  a  case  of  my  own  the  patient  occasion- 
ally found  herself  in  the  morning  lying  at  the  foot  of  the  bed 
with  the  bed  clothing  twisted  about  her,  and  upon  several  oc- 
casions her  tongue  was  sore,  and  her  mouth  contained  blood. 
Subsequently  she  had  well  marked  attacks  in  the  day-time. 

I  have  spoken  of  the  detection  of  nocturnal  epilepsy  by  the 
appearance  of  blood  upon  the  pillow,  and  by  involuntary  dis- 
charges of  urine.  A  case  reported  by  du  Saulle  is  of  consider- 
able medico-legal  interest,  the  subject  being  a  young  man,  an 
army  officer,  who  was  accused  of  desertion  before  tlie  enemy, 
and  his  punishment  would  have  been  severe  indeed  if  it  had 
not  been  for  the  fact  that  his  conduct  was  explained  by  epi- 
lepsy, which  had  not  been  detected,  and  was  not  suspected 
until  the  fact  was  ascertained  that  he  liad  incontinence  of  urine 
and  nocturnal  attacks. 

Tardieu  refers  to  cases  where  the  connection  of  nocturnal 
discharges  of  urine  with  epilepsy  was  clearly  established,  and 
relates  the  case  of  an  elderly  woman,  whose  friends  sought  to 
place  her  under  restraint,  because  she  made  motiveless  assaults 
upon  them  ;  but  an  examination  of  lier  mental  condition  failed 
to  reveal  any  sign  of  disease.  Her  intelligenco  was  ordinary, 
her  memory  being  alone  affected,  and  after  a  long  examination 
Tardieu  had  ahnost  made  up  his  mind  she  should  not  be  commit- 


EPILEPSY,  233 

ted,  when  he  accidentally  learned  that  she  had  a  vesical  trouble. 
His  suspicions  were  excited,  and  after  a  series  of  questions  he 
ascertained  that  she  had  for  along  time  complained  of  inconti- 
nence of  urine,  migraine,  and  undoubted  vertigo  of  an  epileptic 
character,  which  had  lasted  for  fifteen  years  ;  and  it  was  be- 
yond dispute  that  her  attacks  of  violence  were  epileptic. 

The  case  is  related  by  du  Saulle  of  an  English  lord,  who  was 
shot  in  a  drawing-room  in  London,  by  one  of  his  secretaries, 
who  was  laboring  under  a  fit  of  irascibility.     No  explanation 

could    be   given    for    this    conduct,    and    Lord  —   could 

not  think  of  any  provocation,  for  he  had  always  been 
on  the  best  of  terms  with  the  young  man,  and  there  never 
had  been  any  misunderstanding.  The  author  of  the  crim- 
inal act  was  arrested  in  Paris,  as  he  was  about  to 
leave  a  well-known  restaurant,  and  du  Saulle  was  re- 
quested to  examine  him.  The  man  was  twenty-seven  years  old, 
had  passed  his  urine  in  bed  two  or  three  times  a  month,  his 
father  had  died  of  chronic  alcoholism,  and  a  younger  brother 
had  committed  suicide.  He  declared  that  he  had  no  knowl- 
edge of  what  had  passed  and  expressed    great  happiness  at  not 

having  killed  Lord ,  whom  he  had  always  respected  and 

loved.  The  accused  presented  numerous  traces  of  tongue- 
biting,  and  du  Saulle  diagnosticated  nocturnal  epilepsy.  The 
young  man  afterwards  became  insane,  and  was  treated  by 
English  physicians  for  his  trouble. 

Epilepsy  and  Hallucinations. — The  crimes  committed 
by  epileptics  are  often  prompted  by  hallucinations.  I  have,  in 
another  place,  alluded  to  those  sensory  forms  of  epilepsy  in 
which  hallucinations  take  the  place  of  the  ordinary  disturbance 
of  motility,  and  it  is  easy  to  conceive  how  the  insane  condition 
may  cause  the  individual  to  convert  these  into  delusions. 
Brierre  de  Boismont  refers  to  the  case  of  "An  epileptic  who 
after  abandoning  himself  to  great  violence  in  a  church,  went 
into  a  field  and  killed  three  persons.  On  coming  to  himself  he 
exhibited  the  greatest  sorrow.  In  his  frenzy  he  imagined  he 
saw  flames.     His  sequestration  was  very  judiciously  ordered." 

The  Question  of  Memory  in  Relation  to  Epilepsy. — 

As  I  have  shown  in  a  previous  case,  the  epileptic  may  commit 
the  most  terrible  crimes  during  a  paroxysm  and  yet  be  subse- 
quently entirely  unconscious  of  what  he  has  done. 

Delaisauve  reports  the  following  case  : 

"  Joachim   Haeve,  for  a  long  time  an  epileptic,  atrociously 


234  MEDICAL    JURISPRUDENCE. 

murdered,  July  19,  1826,  a  girl  named  Lange,  aged  eleven 
years.  She  was  gathering  wood  in  the  court  yard  with  the 
murderer's  nephew,  when  he  descended  in  his  shirt,  turned 
back  to  strike  his  nephew,  who  offered  him  something  to  eat, 
but  not  succeeding  pursued  the  other  child,  who  had  fled  from 
fear.  The  presence  and  the  cries  of  the  mistress  of  the  estab- 
lishment, far  from  serving  to  intimidate  him.  seemed  only  to 
increase  his  fury  and  to  excite  him,  under  a  ferocious  impulse, 
to  repeat  useless  mutilations  of  the  body. 

"  The  individual,  naturally  inild  and  peaceable,  had  always 
manifested  an  affection  for  children.  Ties  of  kindred  and  of 
friendship  united  him  to  the  family  of  Lange,  against  whom 
besides  he  had  no  subject  of  animosity.  Series  of  attacks 
intensely  severe  succeeded  each  other.  It  was  proven  that,  on 
the  i6th  and  17th,  two  days  before  the  catastrophe,  he  had  had 
several ;  on  the  i8th  he  exhibited  a  strong  repugnance  to  food  ; 
on  the  morning  of  the  i8th  a  witness  saw  him  in  bed  in  pro- 
found stupor,  and  breathing  stertorously,  which  led  to  the 
belief  that  he  had  just  passed  througli  a  paroxysm. 

"  Haeve  had  but  a  vague  remembrance  of  the  scene  which 
had  transpired.  He  could  recall  only  the  feeling  of  disgust  he 
experienced  the  night  before  for  nourishment, — of  some  soiled 
linen  which  he  had  carried  to  his  sister-in-law, — and  of  resting 
in  the  evening  before  his  door  half  dressed  ;  and  according  to 
his  own  statement,  this  species  of  dullness  always  followed  his 
convulsive  attacks.  He  recovered  his  moral  equilibrium 
slowly  ;  and  even  when  lucidity  seemed  restored,  the  least 
attempt  to  rise  or  to  dress  himself  brought  on  exhaustion, 
cephalalgia,  and  loss  of  perception." 

The  ability  of  the  patient  to  remember  the  nature  of  the 
crime  is  not  always  lost.  In  cases  of  aborted  epilepsy  it  may  be 
so — (that  is  in  cases  in  which  the  patient  immediately  before 
and  after  the  crime  was  apparently  sane) — but  in  the  mania  of 
epilepsy  we  find  numerous  cases  of  patients  who  have  detailed 
their  actions. 

"  Josephine    D ,  subject   in    consequence    of  repeated 

epileptic  attacks  to  habitual  dullness,  who  had  taken  a  young 
girl  of  six  years  into  a  lonely  place,  strangled  her,  and  after- 
wards stolen  her  ear-rings.  This  unfortunate  person  herself 
detailed  the  circumstances  of  her  crime."  This  woman  was 
acquitted  (de  Boismont). 

Epilepsy  and  Marriai^e. — The  following  case,  which  is 
well  known  in  the  literature  of  medical  iurisi:>rudence  is  one  in 


EPILEPSY.  235 

which  a  marriage  contract,  entered  into  by  a  lunatic  who  had 
murdered  his  father-in-law  during  the  ceremony,  was  set  aside  : 
The  patient  was  a  shoemaker  20  years  of  age  whose 
epilepsy  began  some  years  before,  having  been  brought  on 
by  injury  due  to  a  fall.  At  first  the  attacks  were  attended  by 
but  slight  mental  aberration,  but  later  he  became  maniacal  for 
a  period  of  two  or  three  days  when  the  paroxysms  occurred,  and 
would  make  threatening  demonstrations.  At  this  time  he  re- 
solved to  marry  and  two  days  before  the  time  agreed  upon  for 
the  wedding,  severe  pains  in  the  head  warned  him  of  an 
approaching  attack.  He  requested  a  physician  to  bleed  him, 
as  this  operation  had  usually  given  him  relief  at  previous 
times.  The  physician  declined  to  do  so.  He  was  however 
bled  two  days  later,  a  few  hours  before  the  ceremony,  without 
beneficial  result.  During  the  ceremony  he  seemed  moody  and 
reserved,  said  nothingbut  "yes."  The  pain  in  the  head  increased 
in  severity  so  that  he,  on  returning  to  the  house  of  his  father- 
in-law,  was  obliged  to  go  immediately  to  bed.  While  the 
guests  were  at  dinner  he  became  very  violent,  rushed  into  the 
dining  room,  and  attacked  and  chased  several  of  the  guests  out 
of  doors.  He  then  obtained  a  knife,  said  he  must  kill  them  all, 
and  succeeded  in  killing  his  father-in-law  before  he  was  over- 
powered. 

After  three  days  the  delirium  passed  off,  and  he  then  could 
remember  nothing  that  had  transpired  after  the  marriage  cere- 
mony. He  was  committed  to  an  asylum  and  the  Court  was  ap- 
plied to  to  nullify  the  marriage  upon  the  ground  that  he  was 
insane  at  the  time  the  ceremony  was  performed,  the  counsel 
taking  the  view  that  the  headache,  the  moodiness  and  taci- 
turnity were  evidence  that  his  mind  was  at  this  time  diseased. 

The  Court  declared  the  marriage  invalid. 

Unsuspected  Epilepsy  and  Divorce.— The  existence  of 
epilepsy  which  has  been  concealed  by  the  subject  from  the 
other  contracting  party,  may  arise  in  proceedings  for  divorce. 
A  case  apropos  is  related  by  Trosseau  of  a  lady  who  was 
aroused  at  night  by  the  restlessness  of  her  husband,  who  vio- 
lently attacked  her  and  she  was  obliged  to  call  for  assistance. 
This  occurred  again,  and  by  means  of  a  light  she  was  enabled 
to  see  the  patient  in  the  midst  of  a  severe  epileptic  attack,  and 
he  would  again  have  done  violence  if  not  restrained.  In  this 
case  the  patient  had  but  an  indistinct  idea  afterwards  of  his 
condition,  but  he  admitted  having  had  other  attacks  previous 
to  his  marriage  of  a  vertiginous  character.     Hence  it  seems  to 


236  MEDICAL    JURISPRUDENCE. 

me  there  should  be  no  reasonable  excuse  for  denying  a 
divorce,  especially  if  the  patient  was  cognizant  of  his  previous 
disease,  and  neglected  to  communicate  his  knowledge  to  his 
wife. 

Horrible  Nature  (►f  Crimes. —  The  crimes  of  violence 
committed  by  the  epileptic  insane  are  nearly  always  of  a  most 
horrible  nature,  and  while  the  ordinary  maniac  or  melancholic 
may  kill  some  one  in  obedience  to  the  dictates  of  a  delusion, 
the  method  employed  is  usually  commonplace,  and  there 
seems  to  be  no  delight  in  the  contemplation  of  the  death  of 
the  victim.  The  murderous  expression  of  the  psychical  state 
of  the  insane  epileptic  is  usually  in  some  unnecessary  and  ill- 
directed  way. 

A  curious  case  came  before  a  commission  a  few  years  ago 
in  New  York,  the  prisoner  being  an  Irish  woman  named 
Jumish  who  placed  her  infant  child  upon  a  red  hot  stove.  She 
was  indicted  and  tried  and  sent  to  the  State  Asylum  at  Utica. 
She  had  been  an  epileptic  for  nine  years  and  had  had  an 
epileptic  convulsion  one  hour  before  the  deed. 

Tlie  Walworth  case.  —  The  somewhat  famous  trial 
of  young  Walworth  for  the  murder  of  his  father,  occu- 
pied the  attention  of  the  courts  a  few  years  ago,  the 
son  being  found  guilty  after  the  defense  of  epileptic  in- 
sanity was  urged.  The  elder  Walworth  was  a  man  of  un- 
governable temper,  and  Avas  exceedingly  abusive  and  violent 
to  his  wife  who  was  the  mother  of  a  large  family  of  children,  the 
eldest  of  whom  was  the  parricide,  Frank.  After  a  serious 
domestic  scene  the  murdered  man  came  to  New  York  and  was 
followed  by  the  son  who  first  went  to  a  boarding  house  where 
his  father  had  been  in  the  habit  of  staying,  and,  not  finding 
him  there,  went  to  the  Sturtevant  House  from  which  he 
dispatched  a  note  inviting  his  father  to  call  upon  him.  The  latter 
came  the  next  morning,  and  going  to  his  son's  room  was  shot 
by  him  during  an  altercation,  and,  after  the  deed  had  been  ac- 
complished, the  murderer  rushed  down  to  the  clerk  at  the  desk, 
telling  him  what  he  had  done,  and  afterwards  sent  a  telegram  to 
his  uncle  stating  that  he  had  shot  liis  father  three  times,  and 
asked  the  uncle  to  take  care  of  his  mother.  He  then  proceeded 
to  the  station  house  in  Thirtieth  street  and  surrendered  himself, 
giving  up  his  pistol  and  acknowledging  the  act,  alleging  as 
an  excuse,  that  Jiis  father  had  threatened  to  kill  his  mother  and 
her  children.     His  manner  was  perfectly  calm  and  collected 


EPILEPSY.  237 

and  his  subsequent  bearing  in  court  was  dignified  and  unruffled. 
He  had  always  been  a  boy  of  good  morals  and  was  intelligent 
and  universally  liked.  The  son  had  been  present  at  more  than 
one'  quarrel  between  the  father  and  mother  and  at  these  times, 
according  to  the  testimony  of  the  mother,  "he  showed  extreme 
pallor,  and  I  noticed  a  pinched  look  on  his  features  expressing 
severe  suffering,  both  mental  and  physical  ;  it  alarmed  me  so 
much  that  I  did  not,  on  his  account,  afterwards  tell  him  ;  he 
was  very  quiet  and  simply  said  *  That  this  must  not  be  !  '  On 
this  occasion,  in  January,  as  soon  as  I  myself  recovered,  I  no- 
ticed the  same  symptoms  ;  when  he  came  in  he  had  his  hand 
on  his  father's  shoulder,  and  said,  *  Be  quiet  father  ;  '  there 
was  no  further  violence  by  his  father  ;  after  the  first  occasion 
I  rarely  spoke  to  Frank  of  his  father  ;  we  very  rarely  spoke  of 
him  ;  on  a  few  occasions  during  the  first  few  months  when  I 
was  receiving  Mr.  Walworth's  letters,  I  saw  him  reading  them, 
and  noticed  some  of  the  same  symptoms  each  time  ;  afterwards, 
when  I  ceased  to  receive  them,  I  frequently  noticed  similar 
symptoms  without  knowing  the  cause,  and  thought  his  health 
was  affected  ;  once  I  saw  him  most  violently  affected,  as  I 
knew  next  day  by  receiving  the  letter  which  he  had  read  ;  I 
called  up  one  of  the  children  saying  :  '  Frank  is  sick;  '  I  went 
up  and  found  him  with  his  body  rigid  and  this  pallor  of  which 
I  have  spoken  ;  I  applied  such  restoratives  as  I  could,  and  he 
shortly  fell  into  a  profound  sleep  for  an  hour  ;  I  noticed  similar 
symptoms  on  various  occasions,  in  greater  or  less  degree  ;  he 
was,  before  I  let  him  know  about  his  father,  a  very  gay,  joyous 
boy  ;  after  that  he  was  at  times  very  quiet  and  abstracted  ; 
there  was  a  notable  failure  of  his  memory  ;  we  used  to  laugh 
at  his  absent-mindedness  ;  he  would  go  to  his  room  for  some 
article  of  dress  to  go  out  and  come  down  without  it  ;  go  down 
street  and  forget  his  errand,  and  after  locking  up  the  house 
would  go  round  to  lock  up  again,  sometimes  two  or  three 
times  ;  he  was  abstracted  at  the  table  ;  several  times  screams 
from  his  room  woke  me  up  and  I  went  to  his  door  ;  his  pillow 
was  stained  at  times  ;  I  saw  Frank  the  Monday  he  left  Sara- 
toga ;  I  noticed  his  extreme  paleness  then  ;  noticed  his  great 
paleness  ;  when  he  was  in  his  fits  of  abstraction  he  generally 
had  a  sad  look  ;  he  was  always  courteous  to  others,  but  before 
this  he  was  lively  ;  he  was  not  subject  to  fits  of  anger  ;  his 
character,  so  far  as  I  know,  was  invariably  good,  both  as  to 
amiability  and  uprightness  ;  there  was  nothing  to  call  a  vice, 
or,  in  the  ordinary  sense,  an  irregularity  in  him  ;  he  was 
always  amiable  and  kind  in  the  family,  but  not  demonstrative  ; 


23»  MEDICAL    JURISPRUDENCE.. 

he  had  never  in  my  hearing  uttered  any  threats  against  his 
father.'' 

Several  physicians  were  called  by  the  defense  as  well  as  ser- 
vants and  others,  to  prove  the  existence  of  epilepsy,  and  it  ap- 
peared that  he  had  nocturnal  attacks,  that  blood-stains  had  been 
found  on  the  pillow,  that  he  had  convulsions  and  frothings  at 
the  mouth  while  at  Saratoga,  and  that  on  one  occasion  while 
playing  ball  he  became  insensible  for  half  an  hour  A  friend, 
Dr.  Grant,  testified  to  the  existence  of  attacks  which  were 
apparently  epileptic  and  were  connected  with  strange  alterations 
of  behavior. 

Dr.  John  P.  Gray  gave  general  testimony  regarding  epileptic 
insanity,  and  believed  the  prisoner  to  be  irresponsible.  Dr. 
Parsons  was  called  for  the  people,  as  were  Drs  A.  O.  Kel- 
log  and  Meredith  Clymer.  Their  testimony  was  substantially 
to  the  effect  that  the  homicidal  act  in  this  case  was  not  per- 
formed while  the  prisoner  was  in  an  epileptic  condition,  and 
that  he  did  not  suffer  from  epileptic  mania  at  the  time.  The 
prisoner  was  found  guilty  of  murder  in  the  second  degree,  and 
he  was  sentenced  to  State  Prison  for  life.  He  was,  however, 
subsequently  transferred  to  the  Utica  Insane  Asylum  and  dis- 
charged. 

Although  in  this  case  there  is  an  undoubted  history  of  epi- 
lepsy which  had  lasted  for  years,  and  the  boy's  character  had 
undergone  a  decided  change,  there  was  nothing  in  the  nature 
of  the  homicide  to  lead  us  to  believe  that  the  crime  was  exe- 
cuted while  the  prisoner  was  in  an  irresponsible  condition,  or 
was  influenced  by  a  paroxysm.  There  is  no  evidence  that  his 
mental  state  at  the  time  of  the  murder  was  that  known  as  the 
post-paroxysmal  ;  on  the  contrary,  there  is  tlie  liistory  of  mo- 
tive, premeditation  and  deliberation.  The  jjislol  was  brought 
from  Saratoga  for  the  purj^ose,  the  father  was  entrapped  and 
lured  to  his  destruction,  and  the  behavior  of  the  prisoner  sub- 
sequent to  the  killing  was  not  that  of  an  irresponsible  indi- 
vidual. 

In  such  cases  as  this,  tlierefore,  we  are  to  distinguish  between 
crime  that  is  the  direct  result  of  the  epileptic  attack,  and  crime 
that  may  be  performed  through  motives  of  an  ordinary  kind, 
even  though  the  person  has  had  epileptic  seizures  at  other  times, 
and  it  does  not  follow  that  the  disease  in  question  must  neces- 
sarily make  the  subject  irresponsibfe. 

Feigned  Epilepsy. — Epilepsy  is  a  disease  that  is  feigned 
verv  often  by  sailors,  soldiers  and  convicts  who   wish  to  shirk 


EPILEPSY.  239 

work  and  gain  the  comforts  of  the  hospital.  Mendicants 
and  impostors  are  also  apt  to  impose  upon  the  charitable,  and 
it  occasionally  happens  that  instances  occur  of  some  import- 
ance, where  the  turning  point  in  a  law  case  is  the  question  of 
epilepsy.  The  epileptic  paroxysm  may  be  counterfeited  by  a 
clever  person,  or  one  who  is  familiar  with  the  features  of  the 
disease,  so  that  the  casual  ob'server  may  be  deceived,  but  such 
is  not  the  case  when  the  bystander  happens  to  be  a  medical  man. 
There  are  certain  changes  that  are  clearly  involuntary,  and  can- 
not be  produced  by  any  effort  of  the  patient.  The  pupils,  during 
genuine  epilepsy,  are  dilated,  and  the  pulse  and  coloring  are 
peculiar.  The  lividity,  dusky  pallor  or  suffusion  cannot  be 
shammed,  and  the  epileptic  is  apt  to  indulge  in  movements 
which  are  in  no  way  like  the  clonic  convulsions.  A  sign  no- 
ticed by  some  observers  and  declared  to  be  pathognomonic,  is 
the  flexure  of  the  thumb  in  the  palm  ;  the  fingers  holding  it 
down.  This,  however,  is  by  no  means  constant.  Browne  re- 
fers to  a  German  case,  where  the  threat  of  a  medical  officer 
stopped  the  recurrence  of  attacks  in  a  patient  who  was  sham- 
ming. I  have  known  of  cases  where  the  impostor  has  actually 
suffered  all  manner  of  injury  rather  than  confess,  and  the  noted 
Clegg,  "the  dummy  clencher,"  threw  himself  in  one  of  his  pre- 
tended attacks,  from  a  corridor  in  gaol  to  the  floor,  a  distance 
of  nearly  twenty  feet.  Of  course  such  utter  disregard  of  self 
as  this  is  apt  to  deceive  almost  any  one.  The  simulator  is  apt 
to  betray  his  knowledge  of  the  supposed  behavior  of  the  true 
attack,  and  occasionally  overshoots  the  mark.  Percy  reports  a 
case  where  the  pseudo-epileptic  demanded  in  a  loud  voice  the 
instruments  necessary  to  remove  his  testicles  :  a  supposed  popu- 
lar method  of  curing  the  disease. 

Sometimes  the  impostor  will  produce  frothing  by  the  inser- 
tion of  a  piece  of  soap  in  his  mouth.  In  suspected  cases  it  will 
be  well  to  smell  the  prisoner's  breath  or  examine  the  froth. 

If  watched  closely  the  malingerer  may  look  about  him,  or 
show  some  interest  in  the  effect  his  actions  produce.  In  many 
instances  the  false  epileptic  closes  his  eyes. 

The  physical  peculiarities  of  the  genuine  epileptic  are  very 
decided,  both  in  the  interparoxysmal  condition  and  during  the 
seizure.  The  epileptic  usually  presents  an  expression  of  stu- 
pidity and  his  eyes  are  vacant  and  dull.  His  lips  are  swollen, 
and  both  these  and  the  tongue  may  be  found  to  be  the  seat  of 
cicatrices  indicative  of  form.er  injury.  His  head  and  face  often 
present  the  evidence  of  previous  falls,  and  if  the  case  bean  old 
one  the  facial  folds  will  be  found  to   be   deepened.     The  ex- 


24©  MEDICAL   JURISPRUDENCE. 

tremities  are  cold  and  the  venous  circulation  stagnant.  Some- 
times we  will  find  the  existence  of  crops  of  acne  the  result  of 
bromism.  His  manner  betrays  lassitude  and  he  has  little  mus- 
cular force.  He  is  inclined  to  stoop,  to  shuffle  along  and  be 
quiet  and  morose.  Gavin  alludes  to  the  harsh  voice,  "  the  en- 
largement of  the  alae  of  the  nose^  the  thinness  of  the  arms  and 
legs." 

"When  the  fits  have  been  frequent,  the  anterior  part  of  the 
inferior  incisors  are  found  obliquely  worn  down.  In  a  real 
and  most  severe  case  of  epilepsy  occurring  in  a  criminal  at 
Paris,  the  teeth  were  found  worn  at  every  point  where  the  upper 
had  come  in  contact  with  the  lower  jaw.  The  lower  incisors  in 
particular  were  extremely  worn  at  their  fronts,  and  yet  the  in- 
dividual was  only  twenty-two  years  of  age  The  pupils  are 
dilated  and  the  conjunctiva  blanched  and  humid.  The  simu- 
lator can  imitate  none  of  these  appearances." 

If  the  character  of  the  pulse  is  carefully  noted,  it  will  be  found 
that  in  true  epilepsy  it  is  hard  and  slow,  and  in  the  feigned  dis- 
ease  it  is  full   and  quick,  as  a  result  of  the  muscular  exertion. 

Toisiii  Upon  the   Spliygm  >graph  and  Epilepsy. — 

Voisin  has  shown  that  in  true  epilepsy  the  sphygmographic 
tracing  shows  a  few  seconds  before  the  attack  of  grand-mal 
a  change  which  consists  in  a  decrease  in  lieiglit  of  curves,  which 
are  more  round  and  closer  together.  When  the  attack  super- 
venes, two  or  three  little  successive  undulations  in  the  ascend- 
ing stroke,  afterwards  a  series  of  slightly  elevated  curves.  The 
curves  are  more  marked,  and  present  a  superior  convexity,  which 
give  the  idea  of  the  half  of  a  circle  ;  then,  at  the  end  of  several 
minutes  the  lines  are  lengthened  perpendicularly  to  a  height 
three  or  four  times  greater  than  before  the  attack.  The  dura- 
tion of  this  pulse-form  varies  from  half  an  houv  to  an  hour  and 
a  half,  sometimes  several  hours  after  the  attack.  * 

Clegg,  the  "  Dummy  Chncker." — Dr  Carlo's  MacDon- 

ald  relates  the  case  of  Clcgg,  the  "  dummy-chucker,''  a  clever 
impostor  who  feigned  epilepsy  for  some  years  so  successfully 
as  to  deceive  the  police  and  many  well-informed  physicians. 
The  following  abstract  f  is  from  Dr  MacDonald's  paper. 
Clegg  had  in  England  carried  on  his  impostures  for  many  years 
quite  successfully. 

"After  his  discharge  from  prison  Clegg  relumed  to  his  na- 

*  Anualcs  (f'/iyi;;iene.^  etc.,  1868 
+  Boston  Mrd.  and  ^urf.   7otinial.  Tan.  6.  1881. 


EKfJ-KPSV.  241 

tive  city,  immediately  rcbbed  his  aunt,  fled  to  London,  thence 
to  Glasgow,  where  he  rcbbed  a  house  of  four  hundred  pounds, 
and  theri  sailed  for  America  Landing  in  New  York  he  re- 
commenced, dummy  chucking,  which,  he  says,  was  something 
new  to  the  'crocked  people  '  of  that  city.  He  joined  a  gang 
of  pickpockets,  and  operated  in  New  York,  Philadelphia,  and 
Boston.  Large  retail  houses  afforded  a  rich  field,  lady  cus- 
tomers being  especially  victims  during  their  consternation  at 
sight  of  a  well-dressed  young  man  writhing  on  the  floor.  The 
ferry-boats,  when  crowded,  offered  excellent  opportunities. 
On  one  of  these  occasions  a  kind-hearted  physician  came  to 
his  assistance,  and  meamvhile  ivas  relieved  of  his  watch.  Un- 
aware of  this,  the  doctor,  on  landing,  called  a  cab  and  took 
the  scamp  to  his  own  office,  where,  after  considerable  effort, 
he  succeeded  in  '  restoring'  the  patient,  about  the  same  time 
discovering  the  loss  of  his  watch.  Clegg  expressed  great  sor- 
row and  denounced  the  outrage,  but  the  doctor  consoled  him- 
self by  the  reflection  that  the  loss  of  the  watch  was  of  little 
consequence  compared  with  the  life  he  had  been  instrumental 
in  saving.  Clegg  admits  that  for  once  his  conscience  smote 
him,  and  avers  that  he  really  tried  to  get  the  watch  for  the 
purpose  of  restoring  it  to  its  owner,  but  it  was  '  sold  '  before 
he  got  back  to  the  city  again.  On  another  occasion  he  feigned 
a  fit  on  a  Fulton  ferry-boat,  and  was  taken  in  an  ambulance  to 
Bellevue  Hospital.  After  pretending  to  sleep  for  an  hour  or 
two  at  the  hospital  he  '  recovered  ;'  but  the  authorities  were 
suspicious  and  detained  him,  as  the  nurse  informed  him,  for 
the  purpose  of  having  him  examined  by  one  of  the  physicians 
of  the  Hospital  for  Epileptics.  In  due  time  the  physician 
from  the  epileptic  hospital  arrived,  and  Clegg,  who  was  on  the 
alert,  hearing  the  nurse  say,  '  There  comes  the  doctor,* 
feigned  a  fit,  and  was  in  '  convulsions  '  when  the  latter  reached 
his  bedside.  The  doctor,  after  watching  him  a  few  moments, 
depressing  his  eyelids,  trying  his  pulse,  and  observing  the 
numerous  cicatrices  on  his  face  and  forehead,  expressed  the 
opinion  that  it  was  a  case  of  epilepsy,  and  Clegg  was  dis- 
charged. 

"  Subsequently  he  was  sent  to  Blackwell's  Island  Prison  for 
stabbing  a  man.  Here  the  chief  of  staff  of  Charity  Hospital 
pronounced  him  an  epileptic.  His  next  commitment  placed 
Clegg  in  Sing  Sing  Prison.  Here  his  '  dummy  chucking  '  be- 
came the  means  of  his  transfer  to  the  Asylum  for  Insane  Crim- 
inals at  Auburn.  At  this  place  Dr.  MacDonald,  on  assuming 
charge,  found  Clegg  in  a  strong  room  and  in  restraint.  He 
t6 


i^i  MEDICAL    JURISPRUDENCE, 

was  said  to  be  *  subject  to  terrible  fits/  Dr.  MacDonald  or- 
dered his  release  from  restraint,  requesting  notification  should 
a  fit  occur.  Shortly  after  he  was  called  He  found  Clegg  on 
the  floor,  his  face  distorted  and  livid,  saliva,  frothy  and  bloody, 
oozing  from  the  mouth  ;  body  apparently  violently  convulsed. 
Two  patients  were  holding  his  limbs.  He  seemed  to  be  having 
a  series  of  rapidly  recurring  convulsions,  each  one  commenc- 
ing with  marked  muscular  rigidity,  the  head  being  drawn  to 
one  side,  the  body  twisted  upon  itself.  Thoracic  muscles  rigid, 
respiratory  movement  almost  completely  arrested.  This  teta- 
noid condition  was  quickly  followed  by  one  closely  resembling 
clonic  convulsions  :  there  were  alternate  contractions  and  re- 
laxions  of  different  portions  of  the  body,  during  which  his 
head  was  frequently  brought  into  such  violent  contact  with  the 
floor  as  to  abrade  the  scalp  ;  his  tongue  was  wounded  ;  respir- 
ation jerking  and  noisy,  and  at  each  expiration  bloody  saliva 
was  forcibly  ejected  from  his  mouth.  Pulse  somewhat  accel- 
erated ;  eyes  turned  upward  as  far  as  possible  ;  pupils  moder- 
ately dilated.  (It  should  be  stated  that  the  room  was  partially 
darkened  by  a  window  screen,  kept  locked.  This  would  ac- 
count for  the  dilatation  of  the  pupils.)  '  His  hands  were 
tightly  clenched,  but  I  observed  that  f/ie  thumbs  were  not  closed 
within  the  hands,  also  that  the  finger  nails  were  not  livid,  and 
wheji  I  forced  his  hands  open  he  immediately  closed  them  again. 
There  were  also  no  visible  indications  of  relaxed  sphincters.  The 
"  clonic  convulsions  "  were  followed  by  a  condition  of  muscular 
quiet,  immobility,  and  stupor,  lasting  for  a  few  moments,  dur- 
ing which  he  would  occasionally  open  his  eyes  and  gaze  around 
in  a  confused  and  stupid  manner,  when,  suddenly,  another 
"  spasm  "  would  supervene.  The  series  of  seizures  lasted  about 
an  hour,  followed  by  a  pretended  sleep,  after  which  Clegg  ap- 
peared to  be  mentally  confused  for  a  day  or  two,  and  com- 
plained of  headache  and  i)hysical  weakness.' 

"  On  this  occasion  Dr.  MacDonald  intimated,  in  Clegg's  hear- 
ing, that  he  was  an  impostor,  although  he  confesses  he  was  not 
positive  at  the  time,  but  deemed  it  safe  to  assume  from  his  his- 
tory that  the  rogue  was  shamming.  Attendants  were  instructed 
to  impress  upon  his  mind  that  the  doctors  regarded  him  as  a 
fraud.  The  next  time  Dr.  MacDonald  met  Clegg  he  accused 
him  of  feigning.  The  man  stoutly  denied  it,  calling  attention 
t"o  the  scars  on  his  head  and  face,  asking  if  the  doctor  thought 
he  would  i)ur])Osely  hurt  himself  like  that,  and  adding  that  he 
had  been  subject  to  fits  since  he  was  three  years  old.  The 
doctor's  suspicions  were  a^ain  awakened  by  the  next  fit.  which 


EPILEfSV.  243 

began  soon  after  he  entered  the  ward.  He  again  said  the  fellow 
was  shamming,  and  that,  while  his  acting  resembled  epilepsy, 
it  lacked  certain  characteristic  features,  the  absence  of  which 
stamped  it  as  counterfeit.  Clegg  subsequently  told  the  doctor 
that  this  announcement  staggered  him.  '  For,'  said  he,  '  I 
have  studied  the  subject  in  books,  have  seen  a  great  many  epil- 
eptics in  fits,  and  have  practiced  it  for  fifteen  years,  until  I 
thought  I  knew  every  symptom  of  it.'  After  he  had  recovered 
from  this  '  attack  '  the  doctor  watched  him  on  occasions  when 
Clegg  was  unaware  of  his  presence,  and  was  struck  with  the 
cheerful  and  vivacious  aspect  of  the  man's  countenance,  as 
compared  with  his  facial  expression  during  the  ward  visits. 
Clegg  could  easily  assume  the  peculiar  indescribable  look  ha- 
bitual to  epileptics.  This,  together  with  the  cicatrices  on  head 
and  face,  might  easily  deceive  even  a  skilled  observer. 

"  By  this  timie  Dr.  MacDonald  felt  justified  in  insisting  upon 
a  confession  from  Clegg,  who  still  denied  feigning,  but  with 
less  emphasis,  until,  the  doctor  forcing  him  still  more,  he  laugh- 
ingly admitted  that  the  fits  were  simulated,  but  mildly  urged 
that  he  was  a  victim  of  real  epilepsy.  This  Dr.  MacDonald 
refused  to  admit,  and  threatened  him  with  unsparing  punish- 
ment in  the  event  of  another  '  fit.'  After  brief  reflection 
Clegg  said,  '  Well,  I  guess  it's  no  use,  but  you  are  the  first 
doctor  that  ever  tumbled  to  me.'  His  countenance  then  un- 
derwent a  decided  transformation,  the  epileptic  look  vanishing 
at  once.  He  was  transferred  to  Auburn  Prison  as  not  insane, 
and  was  released  in  December,  1876.  He  next  went  to  Bos- 
ton, where  he  resumed  the  practice  of  '  dummy  chucking'  in 
connection  with  a  gang  of  pickpockets,  and  afterwards  followed 
the  Marquis  of  Lome  to  Canada,  chucking  dummies  in  the 
crowds  that  gathered.  Returning  to  New  York,  he  was  sent  to 
Sing  Sing  for  burglary,  and  there  played  epilepsy,  which  again 
sent  him  to  the  Auburn  Asylum  as  an  '  epileptic  imbecile.' 
Meeting  Dr.  MacDonald  in  the  ward,  he  threw  off  his  epilep- 
tic mask,  laughing  heartily.  On  this  occasion,  at  the  request 
of  the  doctor,  he  feigned  a  fit,  first  l^orrowing  a  pocket-knife, 
with  which  he  calmly  cut  the  side  of  his  tongue  ;  then,  utter- 
ing the  '  epileptic  cry,'  fell  violently  upon  the  floor  in  a  '  con- 
vulsion.' He  afterward  repeated  the  fit  in  the  presence  ot 
two  other  physicians. 

•"Clegg  made  a  practice,  while  in  prison,  of  complaining  of 
vertigo,  tinnitus  aurium,  etc.,  between  the  paroxysms.  When 
asked  what  remedy  he  had  taken  he  always  replied,  '  Bromide,' 
knowing  that  was  '  the  medicine  the  doctors  e;ive  for  epilcDsv.' 


244  MEDICAL   JURISPRUDENCE. 

Realizing  that  if  he  fell  in  such  a  manner  as  to  avoid  injury 
suspicion  would  be  aroused,  he  never  selected  a  *  soft  place  ' 
on  which  to  fall.  Reynolds*  remarks  that  'choice  of  locality 
(for  falling)  does  not  prove  that  epilepsy  is  feigned  ;  the  ab- 
sence of  choice,  on  the  other  hand,  is  presumptive  evidence 
that  it  is  genuine  ;  and  this  in  proportion  to  the  danger  or  the 
privacy  of  the  locality  in  which  the  fall  occurs.' 

"'Cicatrices  on  the  skin  of  the  face,'  says  Gavin,  'made 
with  the  design  of  presenting  incontestable  proofs  of  anterior 
falls,  never  exist  without  tending  to  deceive  the  medical  man.' 
Clegg  sets  a  high  value  upon  the  scars  upon  his  head  and  face, 
acquired  through  falls.  He  says  they  have  often  served  as  aids 
in  diagnosis  to  examiners  who  have  pronounced  him  '  an  epil- 
eptic." 

"  *  In  conclusion,'  says  Dr.  MacDonald,  'these  are  the 
grounds  upon  which  the  opinion  that  Clegg  was  not  an  epilep- 
tic was  based  :  First,  he  was  a  convict,  sentenced  to  hard 
labor, — this  furnished  a  strong  motive  for  feigning,  and  sug- 
gested sus])icion  ;  second,  the  occurrence  of  a  paroxysm  during 
my  visit  to  the  ward  ;  third,  the  readiness  with  which  he  spoke 
of  his  complaint,  and  called  attention  to  the  cicatrices  on  his 
face  and  head  ;  fourth,  the  marked  change  in  his  facial  expres- 
sion when  he  supposed  he  was  unobserved  ;  fifth,  during  the 
spasms  the  thumbs  were  not  closed  within  the  palms,  the  nails 
were  not  livid,  muscular  rigidity  could  readily  be  overcome,  and 
the  hands,  after  being  forced  open,  immediately  closed  ;  sixth, 
the  sphincters  were  not  relaxed  ;  and,  seventh,  there  were  no 
ecchymoses,  extravasations,  or  minute  petechial  spots  observa- 
ble upon  forehead,  throat,  or  chest.  The  presence  or  absence 
of  pallor  was  not  determined  by  observation  in  Clegg's  case, 
nor  was  any  value  attached  to  the  condition  of  the  ynipils. 

"  As  regards  the  question  of  pallor.  Dr.  MacDonald  agrees 
with  those  who  maintain  that  it  is  not  a  constant  symptom  at- 
tending the  onset  of  epileptic  seizures.  Reynolds  speaks  con- 
fidently of  its  absence  in  some  instances.  In  a  total  of  forty- 
five  observations  recorded  by  him,  '  pallor  was  observed  in  but 
little  more  than  one-fourth  of  the  cases.'  Owing  to  its  exceed- 
ingly evanescent  character,  its  presence  can  be  determined  only 
in  cases  observed  from  the  very  commencement  of  the  attack. 
My  experience  leads  me  to  conclude  that,  as  a  rule,  in  general 
practice,  persons  suffering  from  epileptic  attacks  do  not  coriie 
under  medical  observation  until  the  '  pallid  stage  '  has  passed. 

■^-  Epilt'iisy,  its  Syn^ptoms  and  'rieatment,  page  285. 


EPILEPSY.  245 

Ot  course  it  cannot  be  feigned  ;  and  while  its  recognition 
might  warrant  the  dismissal  of  suspicion  of  shamming  in  a 
doubtful  or  suspected  case,  its  absence  in  a  given  case  would 
by  no  means  justify  a  verdict  of  feigning. 

'"  Respecting  the  condition  of  the  pupils  during  an  epileptic 
attack  authorities  are  also  divided,  some  claiming  that  the  iris 
expands,  a  few  that  it  contracts,  while  others  declare  that  it 
oscillates.  The  important  point  relating  to  the  condition  of  the 
pupils  in  epilepsy,  as  regards  its  diagnostic  value,  is  that 
during  a  paroxystn  they  are  insusceptible  to  the  influence  of  light. 
This  fact  would  be  of  great  service  as  a  means  of  diagnosis  of 
feigned  epilepsy,  but  for  the  difficulty  of  determining  its  pres- 
ence or  otherwise  in  a  person  violently  convulsed." 

The  Case  of  Max  Klinger. — As  I  have  said  there  are  cases 
where  the  defense  of  epilepsy  is  a  somewhat  difficult  one,  the 
courts  refusingto  take  into  account  what  seem  to  be  problemati- 
cal excuses  for  the  prisoner's  conduct.  The  case  of  Max  Klinger, 
a  boy  of  18  years,  is  reported  by  Dr.  Banding.  Klingef  was  a 
tailor  apprentice  to  his  uncle,  whom  he  murdered.  The  victim 
was  engaged  making  a  fire  in  the  stove  when  Klinger  approached 
him  from  behind  and  fired  a  pistol,  which  he  held  close  to  his 
head;  killing  him  instantly.  When  the  murdered  man's  wife 
rushed  into  the  room  she  was  struck  down  by  the  boy,  who 
escaped,  after  taking  what  money  he  could  lay  his  hands  on. 
He  was  arrested  and  confessed  his  crime, alleging  as  the  motive 
that  the  uncle  had  angered  him.  The  prisoner  was  convicted. 
It  transpired  subsequently,  that  when  in  Germany  the  prisoner, 
when  a  child,  had  a  fall  from  a  height  of  thirty  feet,  which 
rendered  him  insensible,  and  produced  a  wound  followed  by 
depression  of  the  skull  which  has  existed  since.  After  his  fall 
he  had  been  subject  to  fits  and  suffered  from  temporary  insani- 
ty, and  that  there  was  a  strong  family  history  of  insanity  and 
epilepsy.  As  the  result  of  this  fresh  evidence  a  new  trial  was 
granted,  but  the  prisoner  was  again  convicted.  Dr.  Clymer  in 
commenting  upon  this  case  alludes  to  many  contradictory  and 
inconsistent  features,  showing  that  at  best  the  existence  of  epi- 
lepsy was  doubtful.  It  did  not  appear  that  the  prisoner  had 
actually  had  an  epileptic  attack  upon  the  morning  of  the  mur- 
der. In  fact  there  was  no  evidence  at  all  except  that  given  by 
a  fellow  prisoner  that  he  had  had  one  before  or  after  the  mur- 
der. Clymer  alludes  to  the  ingenuity  and  shrewdness  of  the 
prisoner  as  manifested  in  his  written  account  of  his  disease,and 
I  may  be  pardoned  for  repeating  it.     It  will  be  seen   that  the 


246  MEDICAL    JURISPRUDENCE. 

patient  **  throws  all  responsibility  for  the  crime  on  his  epileptic 
disorder." 

"  This  event  would  not  have  happened,"  the  prisoner  writes, 
"  if  I  had  not  received  the  sickness  just  on  the  29th  November, 
1S69,  (the  day  of  the  murder),  for  I  do  not  think  that  I  will 
get  the  sickness  on  account  of  all  these  troubles.  I  had  often 
said  it  in  German  that  I  should  get  the  sickness  about  this  time, 
and  nobody  should  enter  the  room  until  I  locked  the  door  my- 
self, for  I  get  so  crazy  that  I  do  not  know  what  I  am  doing. 
It  is  dangerous  for  any  one  to  be  seen  by  me  when  I  get  the 
sickness.  The  doctor  in  Germany  said  to  my  parents  that  I 
would  become  dangerous  during  my  sickness.  I  am  very  sorry 
that  I  was  so  unfortunate.  I  had  the  sickness  on  the  25th 
November,  and,  unhappily,  the  boss  entered  ;  I  saw  him,  he 
came  toward  me  and  looked  at  me,  when  I  struck  at  something  ; 
then  I  saw  that  he  wanted  to  come  at  me,  and  wanted  to  hold  me 
and  1  got  so  intensely  crazy  that  I  did  not  know  what  I  was 
doing.  How  I  got  the  revolver  in  my  hand  I  do  not  know  nor 
how  he  lay  there.  Then  she  ran  towards  me  and  wanted  to 
strike  me.  I  did  not  know  with  what  I  Struck  her.  But  when 
I  came  to  my  senses  I  saw  what  I  had  done  and  was  scared, 
and  I  left  immediately.  If  I  had  premeditated  this,  I  would 
have  sent  my  clothes  to  some  place.  I  kept  the  pistol  by  me 
every  morning  because  we  had  in  our  neighborhood  about  ten 
Indians.  Every  morning  I  was  first  in  the  store  and  was  afraid 
of  these  fellows."  The  above  statement  is  clearly  suggestive 
of  rank  deception.  It  is  entirely  at  variance  with  the  declara- 
tion made  by  him  after,  that  he  was  angered  and  committed 
the  crime  out  of  revenge,  and  shows  a  memory  of  all  the  cir- 
cumstances which  is  quite  unusual  in  epileptic  homicide.  In 
fact,  it  would  appear  that  the  murder  was  a  cool  and  premedi- 
tated one,  for  he  had  stated  to  the  coroner  that  he  had  made 
up  his  mind  to  kill  his  uncle  the  night  before. 

Deliberation  is  inconsistent  with  epilepsy,  and  just  as  in  the 
case  of  Walworth  it  appears  that  crimes  may  be  committed  by 
epileptic  persons  who  are  perfectly  responsible  and  where  there 
is  1.0  direct  connection  between  the  paroxysmal  condition,  either 
masked  or  pronounced,  and  the  consummation  of  the  crime. 
Epileptics  rarely  use  concealment,  and  their  impulsive  acts  are 
executed  as  freely  in  open  daylight  as  at  any  other  time,  or  in 
the  public  thoroughfare  as  frequently  as  elsewhere.  Other  cases 
have  been  decided  in  the  same  manner  as  those  of  Walworth  and 
Klinger,  and  that  of  Roegiers  was  one  of  the  same  kind  in  which 
there  was  well  marked  premeditation   in   the  commission   of  a 


EPILEPSY.  247 

homicide,  and  though  the  prosecution  admitted  the  existence 
of  epilepsy  in  the  defendant,  he  was  promptly  convicted.  In 
this  case,  however,  the  patient  was  evidently  irresponsible,  for 
his  attacks  of  epilepsy  were  associated  with  periods  of  maniacal 
excitement,  when  he  would  threaten  and  warn  those  about  him; 
and  it  was  testified  that  Roegiers  had  gone  so  far  as  to  sharpen 
a  knife  upon  a  grindstone,  exclaiming  from  time  to  time,  "I'll 
have  your  head."  He  subsequently  sought  his  victim  and 
brutally  murdered  him. 

Homicidal  acts  may  be  committed  by  insane  persons  in  whom 
epilepsy  has  been  a  feature  of  the  disease,  but  where  there  is  no 
reason  to  believe  the  crime  is  a  feature  of  an  epileptic  seizure, 
under  the  influence  of  hallucinations  such  acts  are  committed, 
and  sometimes  there  is  great  premeditation  and  concealment  of 
plans. 

Such  a  case  is  related  by  Brierre  de  Boismont  : 

"  The  lunatic  who  some  years  ago  killed  Dr.  Geoffroy,  chief 
physician  of  the  Avignon  Asylum,  was  epileptic  and  subject  to 
hallucinations.  Several  days  before  the  murder  he  heard  a 
voice  which  said  to  him,  '  Kill  the  doctor  ;  if  you  don't,  you'll 
be  unlucky.'  His  conduct  established,  in  the  clearest  manner, 
that  he  had  contrived  his  plans  and  acted  with  judgment,  facts 
of  which  we  have  repeated  proofs.  When  the  doctor  came  he 
complained  of  a  pain  in  his  foot,  begged  him  to  examine  it,  and 
while  the  medical  man  was  stooping,  seized  him  round  the  body, 
and  plunged  into  his  leftside  a  piece  of  iron  that  he  had  sharp- 
ened some  days  before  for  this  purpose.  Although  it  was  cer- 
tain that  he  had  meditated  upon  his  project,  and  waited  for  a 
favorable  moment  to  put  it  into  execution,  his  antecedents  and 
the  examination  left  no  doubt  as  to  the  derangement  of  his 
faculties  and  his  continuous  state  of  madness  ;  he  was  not, 
therefore,  brought  to  trial. 

Occasionally  we  find  that  homicidal  assaults  are  made  upon 
superintendents  of  asylums  and  others  by  epileptics  which  are 
chiefly  dictated  by  motives  of  revenge,  growing  out  of  their  de- 
tention. In  such  cases  the  commission  of  violence  may  not  be 
dictated  by  delusions,  hallucinations  or  any  insane  impulse. 


CHAPTER  V. 

ALCOHOLISM. 

The  relations  of  alcoholism  to  crime  are  very  intimate,  as  tKe 
records  of  every  prison  will  show — its  connection  with  insanity 
is  too  well  known  to  need  mention.  It  is  not  suri)rising,  there- 
fore, that,  the  attention  of  both  civil  and  criminal  courts  is 
directed  so  often  in  those  channels  which  lead  to  the  deter- 
mination of  the  responsibility  of  the  victims  of  drink. 

Divisions  of  Alcoholism. — It  was  Dr.  Magnus  Huss  who 
first  systematically  studied  the  effects  of  alcohol  upon  the  ner- 
vous system,  and  it  was  he  who  made  the  division  of  acute  and 
chronic  alcoholism.  He  as  well  as  Thorneuf*  considered  three 
varieties  of  alcoholism  : 

1.  Acute  alcoholic  intoxication,  in  which  the  effect  is  always 
immediately  linked  to  the  cause,  and  the  duration  of  which  is 
dependent  upon  the  existence  of  the  cause. 

2.  Subacute  alcoholic  intoxication  supervening  to  the  imme- 
diate action  of  the  cause,  usually  melancholic  in  character. 

3.  Chronic  alcoholic  intoxication,  which  results  in  organic 
changes  in  the  brain  and  nervous  system,  with  accompanying 
insanity. 

Of  350  lunatics  treated  in  Charenton  near  Paris,  when  Dr. 
Thorneuf  was  an  interne,  the  insanity  in  102  cases  was  due  to 
alcohol  ;  of  these, 

15   per  cent,  were  of  delirium  tremens, 
6  "  "     drunken  mania. 

1  "  was  of  congestive  mania. 
34         "         were  of  general  paresis. 

4         "  "      folic  circulaire. 

2  "  "      dementia. 

and    the    remainder   presented    epileptiform    convulsions   and 
anomalous  psychical  symptoms. 

Development  of  Alcoholism. — The  early  stages  of  alco- 
holism and  the  immediate  pathological  and  i)hysiological  effects 

*Annales  Mcdico-Psychologiqiie.  1859,   p.  365. 


ALCOHOLISM.  249 

of  alcohol  are  too  familiar  to  need  extended  description.  The 
physical  aspect  of  the  drunkard  is  also  too  well  known.  He 
presents  the  evidence  of  deficient  motility  which  varies  from 
muscular  feebleness  to  tremor  and  actual  paralysis.  This  loss 
of  tone  is  shown  in  an  unsteady  gait,  a  jerkiiiess  in  the  move-, 
ments  of  his  hands,  and  a  lost  sense  of  localization.  He  pre- 
sents a  tremor  which  is  general,  but  more  marked  in  the  hands 
than  elsewhere.  The  hand-grasp  is  feeble  and  he  may  drop 
any  object  he  takes  up.  His  facial  muscles  are  flabby,  and  in- 
nervation is  defective.  Various  defects  in  sensibility  are  pre- 
sented, and  anesthesia  of  the  extremities  exists,  or  there  may 
be  a  well  marked  hemianesthesia  in  advanced  cases  associated 
with  color  blindness,  and  such  ocular  changes  as  atrophy  of  the 
optic  nerve.  Sensation  is  often  delayed,  and  when  a  pin  is  in- 
serted into  the  skin  he  does  not  detect  the  irritation  for  some 
time.  His  reflex  excitability  is  often  blunted,  and  the  special 
reflexes  are  diminished.  Digestion  is  poor  and  the  bowels 
are  relaxed,  the  food  passing  in  a  partially  digested  state.  The 
urine  is  scanty  and  loaded  with  urates,  or  it  may  contain 
albumen  in  considerable  quantities. 

Mental  State. — Intellectually  the  patient  presents  striking 
manifestations.  There  is  a  gradual  alteration  in  habits  and 
morals.  Intellect  is  sometimes  blunted,  but  as  a  rule  there  is 
a  perverted  condition  which  is  shown  in  depression  and  actual 
melancholia,  with  delusions  of  persecution — and  self-abnega- 
tion. Suicidal  tendencies  are  common.  Hallucinations  are  the 
rule,  and  they  may  be  of  the  most  extraordinary  description. 
Patients  hear  voices  and  see  horrid  reptiles,  as  insects,  toads,  or 
vile  creatures  of  every  kind.  These  hallucinations  are  peculiar 
to  alcoholism.  The  patient  suffers  from  insomnia  and  is  disturbed 
by  hallucinations  at  night.  Memory  is  enfeebled  and  there  is 
finally  a  pitiable  weakness  of  all  the  intellectual  powers,  amount- 
ing to  dementia.  A  permanent  weakened  condition  follows, 
perhaps  one  or  more  attacks  of  delirium  tremens,  and  the  trans- 
ition stage  is  marked  by  early  changes  of  temper  and  habits. 
The  patient  becomes  "  pusillanimous,  distrustful  and  vindic- 
tive." 

The  hallucinations  of  the  victim  of  acute  alcoholism  give  him 
a  sense  of  space,  and  he  rushes  ahead  notwithstanding  the  ob- 
stacles which  he  encounters.  He  may  walk  along  roof  ledges 
or  sit  or  stand  in  open  windows  without  fear. 

Actions  as  Influenced  by  Hallucinations. — The  acts 
committed  by  a  person  who  suffers  from   acute  alcoholism  are 


250  MEDICAL   JURISPRUDENCE. 

of  the  Strangest  nature,  and  are  unexpected  and  startling,  and 
the  explanations  given  by  him  are  often  curious.  The  patient  is 
constantly  under  some  fear  or  dread.  It  may  be  that  he  imag- 
ines that  he  has  committed  some  horrible  crime,  and  seeks  the 
protection  of  the  police,  and  it  is  estimated  by  Dagonet  that, 
after  the  celebrated  Troppmann  murder,  a  great  number  of 
persons  of  dissipated  habits  in  Paris  surrendered  themselves  to 
the  authorities. 

Insane  Drunkards. — Wynter  speaks  of  a  class  of  peo- 
ple— those  who  really  need  the  protection  of  the  law,  and  who 
are  to  all  practical  intents  and  purposes  insane.  They  drink 
furiously  and  to  great  excess  without  any  regard  to  the  conse- 
quences. No  obligation  is  too  sacred  for  them  to  break,  and 
when  insanely  drunk,  no  crime  too  horrible  to  commit. 

"  The  most  common  and,  as  regards  society  and  themselves, 
the  most  terrible  of  these  minor  offshoots  of  the  insane  diathe- 
sis, are  the  moral  diseases,  such  as  dipsomania,  or  drink  mad- 
ness. To  the  ordinary  observer  the  dipsomaniac  is  nothing 
more  than  an  utterly  reckless  person,  who  is  determined  to  ob- 
tain drink,  regardless  of  consequences.  He  is  confounded 
with  the  ordinary  drunkard,  and  his  infirmity  is  looked  upon  as 
a  simple  vice.  But,  in  reality,  the  two  cases  are  utterly  unlike. 
Whilst  in  the  case  of  the  ordinary  toper  drink  is  only  the  ac- 
companiment of  the  festive  board  ;  in  the  dipsomaniac  it  is  a 
secret  vice.  He  will  indeed  avoid  drinking  in  company,  and 
assume  the  virtue  of  temperance  all  the  time  that  he  is  madly 
looking  for  liquor  ;  and  when  he  cannot  obtain  it,  will  drink 
even  '  shoe-blacking  and  turpentine,  hair-wash,  or  any  thing 
stimulating,'  says  Dr.  Skae.  There  is  one  feature  in  the  dipso- 
maniac which  is  very  observable  ;  he  is  invariably  good  tem- 
pered when  not  suffering  from  the  physical  depression  which 
follows  the  indulgence  of  his  desir^.  My  own  experience  of 
cases  under  my  charge,  and  which  I  have  watched  narrowly, 
leads  me  to  the  conclusion  that  the  dipsomaniac  is,  without  ex- 
ception, a  happy-go-lucky  sort  of  person,  with  whom  thcAvorld 
appears  to  go  smoothly.  The  worst  feature  of  the  disease  is 
the  very  small  percentage  of  cures  which  are  obtained.  Among 
women  there  appears  to  be  more  chance  thnn  among  men,  as 
the  irresistible  desire,  in  some  cases,  leaves  them  after  a  cer- 
tain period  of  life.  But  their  case  is  rendered  the  more  dis- 
tressing, as  it  usually  happens  that  the  most  refined  natures, 
under  such  circumstances,  are  transformed  into  the  lewdest  and 
the  most  shameless  of  their  sex," 


ALCOHOLISM.  25 1 

Epileptiform  Attacks. — Epileptiform  attacks  are  often  a 
grave  feature  of  advanced  alcoholism,  and  are  always  a  serious 
phase  of  the  disease.  They  are  violent  and  occur  usually  in 
groups,  one  immediately  after  the  other.  Axenfeld  refers  to  a 
condition  of  delirium  following  a  more  or  less  prolonged  col- 
lapse, to  which  he  has  given  the  name  "  Larvated  Epilepsy." 
The  cases  I  have  met  with  were  characterized  by  a  much  more 
deep  and  protracted  form  of  stupidity  than  is  usually  seen  in  non- 
alcoholic epilepsy,  and  the  subsequent  sleep  stage  was  longer  and 
more  profound.  Tongue-biting  is  common.  The  attacks  may  oc- 
cur five  or  six  times  a  day,  and  may  be  associated  with,  or  fol- 
lowed by  hallucinations,  mild  delirium,  a  temporary  loss  of 
memory,  or  a  transient  aphasia  which  lasts  as  a  post-epileptic 
condition.  The  effect  of  repeated  convulsive  attacks  upon  the 
general  nervous  system  is  debasing,  and  there  is  a  feebleness 
both  of  mind  and  body  which  is  distressing  ;  in  a  late 
stage  there  will  be  irregularity  of  the  pupils,  embarrass- 
ment of  speech,  and  a  condition  suggestive  of  general 
paresis.  Hereditary  influence  is  a  bad  feature  of  this  form  of 
alcoholic  disease. 

Impulses  in  the  Alcoholic  Epileptic. — Epileptic  at- 
tacks of  alcoholic  origin  are  quite  apt  to  be  preceded  or  fol- 
lowed, according  to  Dagonet,  by  very  decided  intellectual  per- 
version, excitement  and  homicidal  and  suicidal  tendencies,  the 
result  of  delirium,  and  when  the  delusion  has  subsided  the 
patient  has  no  remembrance  of  his  mental  disturbance.  Ac- 
cording to  this  writer  the  impulses  are  transitory.  He  refers 
to  the  case  of  a  man  who  had  drunk  a  glass  of  absinthe  in  the 
day  time  and  another  in  the  evening,  and  at  the  moment  of 
getting  into  bed  was  seized  with  a  kind  of  delirious  frenzy. 
He  left  his  house,  armed  himself  with  a  hatchet  and  went  to 
his  sister's  house  for  the  purpose  of  killing  her,  but  when  he 
arrived  there  he  changed  his  mind,  threw  away  the  weapon  and 
returned  to  his  lodgings.  He  could  not  at  first  recall  what  had 
transpired  while  he  was  under  the  influence  of  the  delirium. 
Eight  days  afterwards  he  again  resorted  to  the  absinthe,  and 
dreamed  that  he  had  killed  his  brother,  and  he  afterwards  re- 
tained the  most  vivid  impression  of  the  dream.  He  subse- 
quently developed  all  the  symptoms  of  acute  alcoholism — the 
spasmodic  movements  of  the  muscles  of  the  face,  trembling, 
cephalalgia,  hallucinations,  and  numerous  others.  We  should 
carefully  weigh  the  possibility  of  masked  or  irregular  attacks 
of  an  epileptiform  character  in  all  cases  of  homicide,  even  when 


252  MEDICAL   JURISPRUDENCE. 

the  crime  has  been  committed  subsequent  to,  or  preceding  the 
attack  of  dehrium  tremens. 

In  France  the  complication,  according  to  Magnan,  arises 
from  inordinate  indulgence  in  absinthe,  iDut  Dagonet  holds  a 
contrary  opinion.  It  Avould  appear  that  the  absinthe  has  no 
specific  influence,  as  in  this  country  where  very  little  absinthe 
is  used,  there  is  much  epileptic  alcoholism. 

Loss  of  Memory   in    Alcoholism. — The    relations  of 

changes  in  memory  are  interesting.  According  to  Dagonet 
this  faculty  remains  confused  for  a  long  time,  but  clears  little 
by  little.  The  loss  of  memory  occurs  in  two  ways — as  a 
consequence  of  alcoholic  epilepsy,  and  as  a  result  of  acute  al- 
coholism of  great  intensity. 

The  patients  cannot  furnish  any  explanation  of  their  con- 
duct. All  they  preserve  is  a  confused  memory.  Forgetfulness 
is  inseparal)le  from  the  loss  of  consciousness  which  belongs  to 
profound  drunkenness.  The  drunkard  is  of  course  not  in  a 
state  to  comprehend  what  goes  on  al^out  him,  and  cannot  ex- 
plain the  motives  which  led  him  to  commit  acts  he  sub- 
sequently regretted. 

Alcoholic  Trance. — Many  cases  have  been  reported  in 
which  individuals  in  a  peculiar  trance  state  due  to  alcoholic 
excitement  have  committed  outrageous  acts  which  they  are 
entirely  unconscious  of  afterwards.  In  these  instances  there 
has  been  no  history  of  profound  intoxication,  but  often  the 
quantity  of  alcohol  has  been  inconsiderable.  The  mental 
state  after  recovery  has  been  quite  active  and  Dr.  Mercier  has 
expressed  his  astonishment  in  a  case  where  the  man  had  com- 
mitted a  purposeless  act,  while  he  was  stupid  and  incoherent, 
but  subsequently  developed  a  most  remarkable  control  over 
his  faculties.  In  a  discussion  upon  Motet's  paper  upon  this 
subject  read  before  the  International  Medical  Congress  Dr. 
Mercier*  said  : 

"  Alcoholic  mania,  although  very  transitory,  might  be  very 
different  from  delirium  tremens.  Another  case  was  that  of  a 
man  who  was  crying  out  in  the  streets  that  people  were 
taking  his  life  by  means  of  the  telegraph  wires.  He  was  then 
in  a  state  of  acute  mania,  with  delusions,  and  on  the  following 
morning  he  was  completely  well.  In  this  case  also  the  man, 
being  a  teetotaler,  had  suddenly  taken  a  considerable  dose  of 
alcoholic  liquor." 

* 'journal  of  Mental  Science,  Oct..  1881. 


ALCOHOLISM.  253 

"  Dr.  Maudsley  suggested  whether,  in  these  cases  of  moral 
transition,  there  might  not  have  been  a  strong  hereditary 
epileptic  tendency.  It  occurred  to  him  that  in  these  cases  of 
genuine  acute  mania  of  a  transient  kind,  during  which  the  per- 
son was  unconscious,  or  would  forget  afterwards  what  he  was 
doing,  that  kind  of  a  mania  might  be  a  sudden  outbreak  in 
consequence,  perhaps,  of  the  patient's  having  drunk  too  much." 

Dr.  Crothers,  a  fertile  writer  upon  alcoholic  insanity,  sums 
up  his  conclusions  m  regard  to  the  trance  state  which  may 
arise  from  inebriety  and  illustrates  them  by  a  case  which  I 
present  : 

"  I.  The  trance  state  is  a  common  symptom  of  inebriety,  in 
which  the  patient  is  without  consciousness  and  recollection  of 
present  events,  and  gives  no  general  evidence  of  his  real  con- 
dition.    This  may  last  from  a  few  moments  to  several  days. 

"  2.  This  state  is  clear  evidence  of  profound  disturbance 
of  the  higher  brain  centers,  and  is  of  necessity  followed  by 
impaired  judgment  and  lessened  responsibility. 

"  3.  This  trance  state  will  always  be  found  associated  with 
a  particular  neurotic  condition,  either  induced  by  alcohol  or 
existing  before  alcohol  was  used.  In  all  chronic  states  of  in- 
ebriety it  will  be  found  present  in  a  greater  or  less  degree. 
The  first  fact  is  supported  by  the  evidence  found  in  the  his- 
tory of  every  case  of  inebriety." 

Trance  following  inebriety — Automatic  Recovery. 

"  A  railroad  conductor,  aged  45.  Parents  farmers,  and  healthy  ; 
no  evidence  of  inherited  disease.  He  grew  up  a  strong,  ro- 
bust boy,  and  at  twenty-two  went  on  the  railroad  as  baggage- 
master.  Ten  years  later  he  married  and  was  promoted  to  a 
conductor.  He  was,  up  to  this  time,  temperate  and  regular  in 
all  his  habits,  using  no  spirits  except  beer  at  long  intervals. 
A  few  months  after  his  promotion  to  conductor,  his  train  ran 
down  an  embankment  and  was  wrecked.  Many  lives  were  lost, 
and  he  was  greatly  excited,  fearing  the  censure  of  the  company 
and  public,  remaining  at  the  scene  of  the  accident  over  twenty 
hours  without  rest  or  food.  He  then  went  home  and  drank 
spirits  to  profound  intoxication,  remaining  in  bed  two  days  be- 
fore he  went  to  work  again.  From  this  time  he  began  to  use 
brandy,  and  occasionally  was  intoxicated  at  home  at  night. 
Two  years  after  he  complained  of  restlessness  and  inability  to 
sleep  at  night ;  for  this  bitters  were  prescribed,  which  brought 
relief.     His  disposition  began  to  change,  and  he  became  more 


254  MEDICAL    JURISPRUDENCE 

excitable  and  impatient  of  opposition.  A  year  or  more  after 
he  began  to  drink  regularly  when  the  work  of  the  day  was  over. 
and  by  nine  or  ten  in  the  evening  was  heavy  and  stupid  from 
the  effects  of  spirits.  He  was  very  exact  and  methodical  in 
all  his  habits,  drinking  beer  through  the  day,  and  never  vary- 
ing the  routine  of  his  life  or  work  from  any  cause.  When 
thirty-six  years  old,  he  complained  of  blanks  of  memory,  or 
periods  in  which  he  could  not  remember,  terminating  suddenly, 
leaving  him  in  some  strange  position  with  all  the  past  a  blank. 
His  usual  habit  was  to  drink  in  the  evening,  either  at  home  or 
at  the  club,  come  home  always  at  ten  o'clock,  and  retire,  get 
up  next  morning  at  4  A.  m.,  and  take  his  train  a  little  later. 
These  blanks  would  come  on  in  the  evening  and  break  up  at 
some  point  on  the  road  the  next  day  ;  or  they  would  last  until 
late  in  the  afternoon,  on  his  return  trip.  He  would  then  show 
much  anxiety  to  know  what  had  taken  place  in  meantime,  fear- 
ing he  had  made  some  mistake,  and  inquiring  minutely  of  his 
wife  and  some  intimate  friends.  These  blanks  increased,  and 
were  noted  by  his  brother-in-law,  a  physician,  as  follows  :  He 
would  come  home  at  night  heavy  and  stupid,  not  unconscious, 
apparently,  but  still  and  quiet  ;  sleep  soundly  until  morning, 
get  up  at  the  regular  hour,  talk  but  little,  take  breakfast  as 
usual,  go  out  on  his  train,  read  the  paper,  attend  to  all  the  du- 
ties of  his  business  in  a  quiet  mechanical  way.  If  any  thing 
unusual  happened  he  seemed  to  be  more  indifferent,  and  acted 
with  judgment  and  caution.  All  at  once  he  would  seem  to 
awaken,  his  manner  would  be  nervous,  and  his  eyes  would  in- 
dicate alarm,  he  would  look  over  his  change  and  tickets,  and 
inquire  of  any  one  who  was  intimate  with  him  as  to  what  had 
taken  place,  having  no  idea  of  any  thing  from  some  time  in  the 
evening  before.  He  would  remember  some  question  or  topic 
of  conversation  that  occurred  in  the  company  in  the  past  even- 
ing, and  be  ready  to  go  on  with  the  conversation,  only  the  cir- 
cumstances had  changed,  and  the  interval  was  a  blank.  This 
state  would  alarm  him,  and  he  would  drink  less  for  a  few  weeks. 
He  never  was  delirious,  but  complained  of  heaviness  and  desire 
for  sleep.  When  he  was  sober  he  would  be  nervous  and  irritable, 
and  then  use  spirits  to  steady  his  nerves. 

"  The  treasurer  of  the  road  noted  this  condition,  in  his  inabil- 
ity to  make  out  the  returns  when  his  trip  was  over.  He  would 
count  and  recount  his  money,  then  give  it  up,  saying  his  head 
ached  and  he  could  not  get  it  correct  ;  the  next  day  it  would 
be  satisfactorily  settled.  The  blanks  increased  in  length,  and 
would  last  from  the  evening  until  the  return  from  his  daily  trip 


ALCOHOLISM,  255 

the  next  day,  twenty  hours  or  more.  During  this  time  he  would 
not  seem  to  be  in  any  way  different  to  the  train  men.  Once, 
when  an  accident  had  occurred,  he  recovered  his  senses,  and 
was  unusually  excited  ;  on  other  occasions  he  would  have  men 
put  off  the  train,  and  pass  through  exciting  scenes,  yet  have  no 
memory  of  them,  and  be  unable  to  make  up  a  report,except  from 
the  assistance  of  a  brakeman.  He  tried  to  break  up  the  use 
of  stimulants,  but  failed,  saying  he  would  become  insane  if  he 
stopped  ;  then  he  diminished  the  quantity,  but  always  came 
back  to  the  usual  amount,  which  was  followed  by  more  or  less 
stupor  at  night.  Both  his  wife  and  brother-in-law  noted  these 
trance  states,  and  fully  verified  his  statements  of  no  recollec- 
tion of  events.  He  seemed  to  be  more  suspicious  as  he  grew  older, 
and  urged  that  every  thing  be  put  in  writing.  On  the  road  in 
this  state,  if  he  was  asked  for  a  favor  he  put  it  down  on  paper, 
and  urged  that  others  do  the  same  to  him.  When  not  in  this 
condition,  he  was  quite  careless  about  little  things,  but  when  he 
became  exact  and  very  particular  his  friends  knew  that  he  was 
not  able  to  comprehend  his  state.  He  rarely  drank  except 
when  at  home,  and  whenever  he  felt  that  he  had  used  more  than 
he  could  bear,  went  quietly  to  bed  ;  always  seeming  to  have  an 
inner  consciousness  of  his  situation,  seen  in  the  caution  which 
he  displayed  to  keep  from  observation.  For  over  three  years 
these  blanks  continued,  sometimes  every  week,  then  at  longer 
intervals,  but  steadily  increasing  in  duration,  and  becoming 
more  prominent  in  the  heavy  stupid  air  and  manner  of  doing 
business.  He  resigned  and  spent  a  year  on  the  farm,  using 
less  alcohol  and  recovering  rapidly.  He  is  now  in  business, 
and  has  had  no  blanks  for  two  years,  but  at  times  after  he  has 
drank  two  or  more  glasses  of  beer  his  memory  is  confused  for 
an  hour  or  more." 

Changes  in  Character.— The  effects  of  alcohol  are.  rarely 
the  same  in  different  individuals,  and  no  rule  will  work  uni- 
versally. Some  men  lose  their  business  capacit)^,  while  others 
become  pugnacious  or  irritable,  and  at  the  same  time  are  ener- 
getic and  show  little  sign  of  weakness.  Some  drinkers  succumb 
almost  immediately  to  small  quantities  of  stimulant,  while 
others  seem  to  be  little  affected. 

Heredity. — The  abnormal  craze  for  drink  is  often  the 
direct  result  of  the  insanity  or  intemperance  of  ancestors. 
Even  when  carefully  environed,  the  trouble  breaks  out,  and 
several  members  of  the  same  family  are  apt  to  be  affected.  In 
such  families  the  children  of  decent  parents  may  reproduce  the 


256  MEDICAL  JURISPRUDENCE. 

behavior  of  maternal  or  paternal  grandfathers.  Vicious  in- 
stincts and  alcoholism  go  hand  in  hand  ;  one  brother  may 
become  a  thief,  who  does  not  drink — another  may  commit  no 
greater  crime  than  those  of  a  light  sort  arising  from  his  drunk- 
enness. 

Dr.  Bucknill  considers  that  insanity  may  directly  follow 
drink  ;  or  that  it  may  arise  from  some  other  influence  such  as 
mental  strain,  which  causes  drink-craving.  Drink  concurring 
and  continuing  with  other  causes  and  producing  a  progressive 
effect,  the  end  of  which  is  the  evolution  of  madness. 

Fixed  Ideas. — Fixed  ideas  are  all  of  a  horrible  nature. 
The  victim  of  alcoholism  firmly  believes  that  he  is  the  object 
of  attack  of  a  well  organized  conspiracy — that  he  is  to  be  pois- 
oned or  killed.  He  is  often  impelled  in  consequence  to  attempt 
homicide  or  suicide.  These  delusions  may  be  connected  with 
maniacal  excitement.  Sometimes  they  may  be  of  an  expanded 
character.  The  extravagant  ideas  of  the  patient  suggest  general 
paresis  very  strongly,  and  in  fact  this  disease  may  and 
often  is  a  direct  outgrowth  of  the  alcoholic  state.  Irregular 
forms  of  alcoholism  are  quite  likely  to  be  called  general  paresis, 
but  there  is  a  difference. 

Delirium  Tremens  and  Responsibility.— Delirium  Tre- 
mens has  been  advanced  as  a  defense  very  often  in  murder  cases, 
and  in  the  case  of  the  Queen  vs.  Burns  Baron  Bramwell  charged 
the  jury  to  acquit  if  they  believed  the  prisoner  to  be  suffering 
from  a  delusion,  which  if  true  would  have  justified  him  in  the 
act.  If  through  drink  his  mind  had  in  their  opinion  been 
substantially  impaired,  they  were  to  acquit  him  which  they 
did. 

The  distinction  between  delirium  tremens  and  temporary 
madness  induced  by  intoxication,  is  laid  down  in  the  United 
States  vs.  Drew,  5  Mason,  28  and  (in  England)  in  Jolin  Bur- 
roughs' case,  I  Lewin,  C.  C,  75.  In  the  latter  case,  Holroyd, 
J.,  said  :  "  Drunkenness  is  not  insanity,  nor  does  it  answer  to 
what  is  termed  an  unsound  mind,  unless  the  derangement 
which  it  causes  becomes  fixed  and  continued  by  the  drunken- 
ness being  habitual,  and  thereby  rendering  the  party  incapable 
of  distinguishing  between  right  and  wrong." 


ALCOHOLISM. 


257 


Diagnosis  between  Alcoholism  and  General  Para- 
lysis.— The  following  table,  prepared  by  Thorneuf,  sums  up 
the  diagnostic  points. 

General  paralysis. 

Generally  no  headache. 
Enfeeblement   of   the   understand- 
ing, rarely  hallucinations. 

Ideas  of  grandeur  and  contentment' 


Alcoholic  Insanity  complicated  with 
paralysis. 

Headache. 

Active  hallucinations  affecting  all 
the  senses,  disordered  vision  (illu- 
sions). 

Delirious  conceptions  depending 
upon  hallucinations  ;  ideas  of  perse- 
cution, tendency  to  suicide,  evil  in 
stincts,  consciousness  of  degradation. 

Embarrassed  speech  depending 
somewhat  upon  fear,  upon  startings 
of  the  muscles  of  the  face  and  espec- 
ially upon  tremulousness  of  the 
tongue. 

Feebleness  little  marked  of  the  in- 
ferior members  ;  equal  on  both  sides. 

Trembling  of  the  hands  and  the 
arms  more  marked  in  the  morning  ; 
formications,  cramps  and  startings  of 
the  tendons  of  the  fore-arm. 

Pupils  nearly  always  dilated. 

Anesthesia  of  the  extremities  of 
the  limbs  extending  generally  in  the 
superior  limbs  to  the  elbow,  and  in 
the  inferior  to  the  knee. 

Sleep  disturbed  with  dreams,  some- 
times sleeplessness. 

Diminution  of  appetite,  acid  eructa- 
tions, vomiting  of  mucus  in  the 
morning. 

Dimunition  of  the  generative  func- 
tions, frigidity. 

Readily  cured  or  modified. 

Occasional  supervention  of  delirium 
tremens. 


Einbarrassed  speech  depending 
upon  feebleness  of  the  conceptions 
and  paraly.sis  of  the  muscles  of  the 
face. 

Feebleness  of  the  inferior  members, 
more  marked  generally  upon  one  side 
than  the  other. 

Nothing  apjireciable  in  the  superior 
limbs,  sometimes  default  of  co-ordin- 
ation. 

Pupils  often  unequal,  often  con- 
tracted. 

Sensibility  normal,  or  obtuse  over 
the  whole  surface. 


Sleep  generally  normal.     . 
Appetite  augmented. 

Augmentation     of    the   generative 

functions- 
Progress  of   the  disease  ordinarily 

rapid,  always  fatal. 

Tendency   to   congestions,   and  to 

epileptiform  attacks. 

Responsibility    and    Alcoholism. — Mere    drunkenness 

does  not  bring  with  it  immunity  from  punishment.  The  law 
is  not  so  lenient.  When  the  drunkenness  of  the  criminal  leads 
him  to  commit  an  act  as  the  result  of  an  illusion,  hallucination 
or  delusion,  the  matter  is  different.  It  must  be  shown  that  he 
actually  suffers  from  disease  of  the  mind.  Under  this  head  we 
find  some  cases  of  chronic  alcoholism,  of  dipsomania  and  of 
acute    alcoholism   with    delusions    and    hallucinations.      The 

17 


258  MEDICAL   JURISPRUDENCE. 

delusion  or  hallucination  must  moreover  exist,  or  in  some 
way  be  connected  with  the  act.  If  the  person  defends 
himself  from  imaginary  enemies  he  will  be  clearly  irrespon- 
sible. 

Taylor  says  in  this  connection  :  "  If  the  drunkenness  has 
produced  a  diseased  state  of  the  mind,  then  a  criminal  act  per- 
petrated by  the  person  might  admit  of  exculpation  either  on 
the  ground  of  insanity  or  of  the  want  of  sane  consciousness  at 
the  time  of  the  act ;  but  the  difficulty  is  to  prove  in  such  cases 
the  existence  of  actual  disease  to  a  sufficient  degree  to  render 
the  person  irresponsible  in  a  legal  sense.  Where  it  is  a  ques- 
tion whether  the  accused  was  actuated  by  malice  or  not,  a  jury 
may  under  certain  circumstances  be  required  to  take  the  fact 
of  drunkenness  into  their  consideration,  and  this  may  have 
some  influence  upon  their  conduct." 

It  may  be  held  that  the  crime  committed  by  a  voluntary 
drunkard  is  an  aggravated  one,  but  the  fact  that  the  man 
v;as  drunk  at  the  time  the  crime  was  committed  sliould  be  con- 
sidered in  relation  to  intention  or  malice.  Browne  refers  to  the 
case  of  King  vs.  Thomas,  in  which  it  was  decided  that  drunken- 
ness is  no  excuse  for  any  crime  a  man  may  commit  ;  still  where 
provocation  by  a  blow  has  been  given  to  a  person  who  kills  an- 
other with  a  weapon  which  he  happens  to  have  in  his  hand,  the 
drunkenness  of  the  prisoner  may  be  considered  on  the  question 
whether  he  was  excited  by  passion  or  actuated  by  malice  ;  and 
it  was  further  held  that  it  may  be  considered  on  the  question 
whether  expressions  used  by  the  prisoner  manifested  a  deliber- 
ate purpose,  or  were  merely  the  idle  expressions  of  a  drunken 
man. 

Le  Grand  dii  SaiiUe  on  Responsibility. — Le  Grand  du 
Saulle  says  of  the  responsibility  of  drunkards:  "With  respect 
to  my  personal  opinions  upon  drunkenness,  they  are  as  follows  : 
The  inveterate  abuse  of  alcoholic  liquors  should  continue 
almost  entirely  without  influence  over  responsibility,  until  there 
is  manifested  and  confirmed  and  persistent  mania.  Habitual 
drunkenness  ought  neither  to  augment  nor  extenuate  the  con- 
sequences of  the  act  committed,  but  it  may  to  a  considerable  ex- 
tent diminish  or  altogether  do  away  with  tlie  suspicion  that  the 
immediate  drunkenness  has  been  contracted  for  a  culpable 
end.  It  is  with  difficulty  one  can  understand  that  the  habit  of 
getting  drunk  should  become,  on  the  part  of  magistrates,  an 
object  of  gracious  consideration  wlien  their  office  is  to  repress 
scandal  and  to  punish  immorality." 


ALCOHOLISM.  25Q 

Case  LI. — Murder — Plea  of  intoxication  in  mitigation 
— Proof  of  plot  made  while  sober — Conviction. 

Hamlin     ) 

vs.         r  48  Conn.  Reports,  92. 
The  State,  ) 

Hamlin  was  convicted  of  murder  in  the  first  degree.  He 
and  one  Allen  made  an  attempt  to  escape  from  the  State 
prison,  and  in  the  attempt  killed  a  watchman  named  Shipman. 

He  then  petitioned  for  a  new  trial  on  the  ground  of  newly 
discovered  evidence  of  his  intoxication  at  the  time  of  the  mur- 
der. It  appears  that  they  had  for  some  time  previous  made 
preparations  for  the  escape  by  bribing  one  of  the  watchmen, 
that  they  had  afterwards  decided  to  escape  by  attacking  the 
guard  and  making  a  bold  dash,  and  that  they  had  waited  for 
two  hours  for  an  opportunity  to  make  the  attack.  It  is  claimed 
that  while  thus  waiting  the  prisoner  drank  some  liquor  and 
became  intoxicated.  In  refusing  the  petition  the  Supreme 
Court  of  Errors  held,  that  conceding  that  Hamlin  was  intoxi- 
cated when  the  attack  was  made,  he  had  previously  partici- 
pated in  all  the  preparations  therefor  even  to  the  extent  of 
taking  human  life,  they  having  armed  themselves  ;  that  in 
view  of  these  facts  the  attack  and  its  consequences  were  pre- 
meditated and  the  intoxication  at  the  time  of  the  murder  could 
be  of  no  avail  as  a  mitigating  circumstance. 


Case   LII. — Murder — Defense    of     Alcoholism — Convic- 
tion. 

Henry  A.  Schlencker  ) 

vs.  >■  9  Nebraska  Reports,  241. 

State,  ) 

The  prisoner  on  Oct.  10,  1878,  while  intoxicated,  went  to  a 
house  of  ill-fame  to  see  one  Florence  Booth  whom  he  requested 
to  lie  down  with  him  which  she  refused  to  do.  A  quarrel 
then  ensued  and  he  shot  and  killed  her  and  then  shot  himself, 
but  subsequently  recovered.  He  was  convicted  of  murder  in 
the  first  degree  and  sentenced  to  be  hung,  but  obtained  a  re- 
prieve and  was  granted  a  re-hearing.  The  defense  set  up  was 
insanity  superinduced  by  alcoholism.  Several  witnesses  testi- 
fied that  on  the  day  of  the  murder  and  for  some  time  previous 
the  prisoner  "  acted  strangely  ;  was  drinking  ;  was  not  in  his 
right  mind  ;  had  eaten  nothing  ;  was  excited  ;  walked  hastily  ; 
acted  queer  ;  tried  to  run   against  us  ;  acted  funnier  than  he 


26o  MEDICAL   JURISPRUDENCE. 

ever  did  before  ;  looked  fierce  ;  had  fits  ;  looked  dreamy,  as  if 
there  was  something  on  his  mind,  etc."  M.  C.  Keith  a  practic- 
ing physician  testified  that  he  examined  prisoner  after  the 
shooting;  "his  blood  was  thin,  red,  arterial,  and  smelt  of  al- 
cohol ; "  he  believed  from  his  condition  that  he  had  been 
drinking  constantly  for  from  three  to  six  months  ;  believed  him 
to  be,  but  would  not  swear  that  he  was,  suffering  with  chronic 
dipsomania  or  oinomania,  which  would  induce  him  at  the  time 
of  the  frenzy  to  kill  even  his  best  friend  ;  his  eyes  were  protu- 
berant ;  believed  from  his  appearance  he  had  just  passed 
through  a  paroxysm  of  madness  ;  a  person  in  this  paroxysm 
knows  nothing  ;  does  not  realize  his  condition  ;  has  a  desire 
to  destroy  life."  The  State  produced  a  number  of  witnesses 
who  testified  with  regard  to  prisoner's  actions  before  and  on 
day  of  murder.  He  seemed  perfectly  sane  ;  walked  straight  ; 
his  face  looked  natural ;  appeared  to  be  all  right ;  saw  him  on 
witness  stand  on  Sep.  30  ;  he  was  a  little  excited  then  ;  noth- 
ing peculiar  in  his  actions  ;  should  say  he  was  sane  from  his 
general  appearance. 

On  appeal  to  the  Supreme  Court  the  conviction  was  af- 
firmed.   

CA:.je:  LIII. — Willful   murder,  defense  insanity. — Pris- 
oner    INTOXICATED     AT      TIMES-  —  FeIGNED      INSANITY. 

Conviction. 

State  ) 

vs.  [-51  Vermont  R.  296. 

Edwin  C.  Hayden,  ) 

Prisoner  who  had  been  separated  from  his  wife  by  reason 
of  his  intemperate  habits,  on  August  30,  1876  called  upon  his 
wife  who  was  living  at  the  Derby  Line  Hotel  in  Derby  Line 
with  her  sister  and  sister's  husband  for  the  purpose  of  effecting 
a  reconciliation.  He  was  somewhat  intoxicated  and  received 
no  encouragement.  The  next  morning,  having  announced  his 
intention  to  shoot  his  wife,  he  again  called  to  see  her,  but, 
being  very  intoxicated,  was  refused  admission  to  her  rooms, 
and  went  away.  He  soon  returned,  however,  and  endeavored 
to  force  his  way  into  his  wife's  room  but  was  resisted  by  her 
brother-in-law,  whom  he  shot  and  then  forced  the  door  of 
the  room  and  shot  his  wife.  After  his  arrest  he  said  he  hoped 
she  would  die  and  he  was  ready  to  l)e  hung.  This  evidence  was 
not  controverted  by  the  prisoner,  but  a  j)lea  of  insanity  was 
put   in.     It  was  claimed  that  when  he  was  under  the  influence 


ALCOHOLISM.  261 

of  liquor  he  was  subject  to  emotional  insanity.  It  was  shown 
that  several  of  prisoner's  ancestors  had  been  insane;  that  while 
in  jail  his  conduct  was  strange  and  unaccountable  and  that 
he  was  sick  and  prostrated.  (On  behalf  of  the  state  a  doctor 
who  had  examined  him  in  a  jail  and  to  whom  prisoner  had 
explained  his  symptoms  stated  that  he  believed  prisoner 
was  shamming).  It  was  also  claimed  that  the  manner  of  the 
shooting  was  proof  of  his  insanity.  Three  witnesses  testified 
that  they  knew  prisoner, ,  had  seen  him  sober,  had  seen  him 
excited,  and  also  intoxicated,  but  believed  him  to  be  sane,  but  no 
further  evidence  was  produced  except  the  opinions  of  experts, 
based  on  the  facts,  which  were  to  the  effect  that  prisoner  was 
not  insane. 

Prisoner  was  convicted  and  on  appeal  to  the  Supreme  Court 
the  conviction  was  affirmed. 

A  recent  Nebraska  case*  in  which  intoxication  as  a  defense 
was  urged  is  that  of  the  State  of  Nebraska  vs.  Schleucher  in 
which  the  prisoner  murdered  a  woman  while  intoxicated.  The 
judge  held  that  "  settled  insanity,  produced  by  intoxication, 
affects  the  responsibility  the  same  way  as  insanity  produced 
by  any  other  cause  ;  but  insanity  immediately  produced  by 
intoxication  does  not  destroy  responsibility  when  the  patient 
when  sane  and  responsible  made  himself  voluntarily  intoxi- 
cated." 

In  the  same  case  it  was  held  that  the  fact  that  the  prisoner 
was  in  a  drunken  state  when  he  committed  the  homicide  does 
not  in  itself  render  the  act  of  shooting  the  deceased  any  the 
less  criminal  nor  is  it  available  as  an  excuse. 

As  an  illustration  of  insanity  directly  due  to  drink  when 
the  question  of  responsibility  is  doubtful,  I  may  quote  the  fol- 
lowing history: 

"  Man,  aged  37,  single,  laborer,  intemperate,  had  suffered 
from  several  attacks  of  acute  mania,  arising  from  the  use  of 
liquor,  and  occurring  after  a  protracted  debauch.  Was  first 
admitted  to  Utica  Asylum  two  years  previously  and  was 
then  violent,  destructive,  sleepless  and  acutely  maniacal,  and 
had  committed  violence  by  knocking  a  woman  on  the  head 
with  a  club.  He  soon  became  quiet  and  returned  home,  where 
he  continued  well  till  present  attack.  He  drank  to  excess  during 
the  interval,  and  three  weeks  before  second  admission  became 
maniacal  and  threatened  to  kill  various  persons.  He  set  fire 
to  the  house  of  his  brother-in-law,  whose  family  was  asleep 


*  Referred  to  in  Boston  Med.  ^  Surg.  Journal,  Jan.  29,  1880. 


262  MEDICAL   JURISPRUDENCE. 

below  and  was  aroused  by  the  noise  of  the  fire.  His  sister 
attempted  to  go  up  the  stairs,  when  she  was  opposed  by  the 
patient  who  struck  at  her  with  an  ax.  This  fortunately 
glanced  off  without  inflicting  serious  injury  He  was  arrested, 
securely  restrained  and  brought  to  the  Asylum.  He  recovered 
after  six  months.  Has  since  bad  another  attack,  and  is  now  in 
the  Asylum." 

The  neurotic  criminal  often  ''  nerves  himself  up  "  and  seeks 
in  alchohol  an  agent  not  only  to  steady  him  for  the  performance 
of  his  crime,  but  to  obscure  his  conscience.  Parrish,  who  has 
had  a  large  experience  in  such  cases,  presents  in  a  recent  work* 
two  or  three  cases,  an  imiportant  example  being  the  following  : 

"  Aged  29,  clerk.  Drinks  to  excess  occasionally  Latterly 
the  occasions  have  been  so  frequent,  that  he  has  'ost  his 
situation.  Upon  further  acquaintance  with  this  youth  1  found 
him  honorable  and  honest,  when  sober,  an  excellent  clerk, 
obliging,  and  given  to  no  other  habitual  vice,,  than  excessive 
smoking.  He  is  sensitive,  and  has  recently  become  suspicious 
to  a  degree  that  makes  intercoui.'sc  ana  conversation  with  him 
a  very  delicate  matter.  At  times  he  was  overtaken  with  an 
impulse  to  commit  an  act  that  was  in  violation  of  hi3  conscience 
and  moral  sense,  but  which  seemed  to  be  irresistible.  The 
very  conflict  with  himself  and  his  temptation  aggravated  his 
nervousness,  and  he  became  wil'ful,  obstinate,  profane,  and 
restless  to  a  degree  that  was  irrepressible.  In  this  stage  of 
extreme  irritability,  he  would  resort  to  whisky  m  great  modera- 
tion. Unlike  the  dipsomaniac,  who  drinks  without  limit,  and 
without  thought,  he  drank  with  great  caution,  taking  a  little, 
with  short  intervals  between.  As  the  circulation  began  to 
create  a  glow  throughout  his  whole  capillary  system  and  his  ex- 
treme nervousness  began  to  yield  to  a  state  of  comparative 
calm,  the  period  of  deliberation  was  reached,  and,  keeping 
himself  at  this  level  by  repeated  draughts  of  liquor,  at  suitable 
intervals,  he  was  enabled  to  plan  and  execute.  His  offense 
was  always  the  same,  and  after  it  was  done  he  suffered  re- 
morse and  sorrow,  and  till  the  next  overpowering  impulse 
posessed  him  he  was  prudent,  sober  and  correct.  This  young 
man  afterwards  settled  in  business  and  became  a  useful  citi- 
zen. His  friends  consider  him  a  "  reformed  drunkard,'' and 
he  is  willing  to  accept  the  title.  He  is  however  a  reformed 
criminal,  if  tlie  propensity  to  crime  is  in  subjection  ;  but  he  was 
never  an  inebriate  in  its  actual  physiological  sense." 

*4lcoholic  Inebricly. — p.  26    Phila,  1883. 


ALCOHOLISM  263 

Anothei  case  is  that  of  a  man,  age  41.  An  agent  for  a  large 
mercantile  firm,  who,  with  a  clear  head  and  steady  hand,  ex- 
ecuted a  forgery,  and  then  deliberately  got  drunk  to  partially 
obscuie  from  his  mind  thoughts  of  the  deed,  but  more  especially 
to  furnish  his  friends  with  a  plea  for  committing  him  to  an  inebri- 
ate asylum,  the  officers  of  which  were  unconsciously  instrumental, 
for  the  time,  in  aiding  a  criminal  to  escape  the  just  sentence  of 
the  law.  I  am  not  aware  that  tins  man  was  ever  intoxicated  af- 
terwards, while  previous  to  this  time  he  bore  a  reputation  for 
sobriety.  He  was  not  an  inebriate  but  a  criminal,  and  yet 
the  fact  of  being  sheltered  for  a  short  time  within  the  walls 
of  a  Sanitarium  gave  him  an  opportunity  to  pass,  on  his 
discharge,  for  a  reclaimed  victim  of  the  bowl,  which  he  pre- 
ferred to  the  shame  of  being  a  forger. 

*'  Another  case  that  came  under  my  observation,  but  not 
under  my  care,"  says  Parish,  "  was  a  convict  in  a  State  Peni- 
tentiary for  the  third  time,  for  manslaughter.  Notwithstanding 
his  homicidal  tendency,  which  seemed  to  be  inherited,  he 
acknowledged  himself  a  coward,  and  it  was  always  with  much 
fear  that  the  impulse  to  kill  was  associated.  Instead  of  the 
daring  and  even  rashness  of  some  homicides,  he  trembled  with 
terror  as  the  impulse  to  destroy  life  seized  and  possessed  him. 
The  conflict  between  the  impulse  and  the  timidity  and  dread, 
which  were  almost  simultaneous  in  their  approach,  made  him 
nervous,  irritable  and  angry.  Under  these  conditions,  he 
resorted  to  the  liquor  in  such  carefully  graduated  quantities 
as  he  imagined  would  secure  care  and  deliberation  in  the 
prosecution  of  his  purpose.  His  purpose  was  to  select  a 
victim  whom  he  could  manage  with  ease,  always  keeping  him- 
self in  the  attitude  of  self-defense,  that  he  might  evade  the  ex- 
treme penalty  of  the  law  for  murder.  He  could,  while  his  own 
anger  and  irritability  were  under  control,  excite  his  antagonist 
to  threats  or  attempted  assault,  during  which  period  he  would 
calmly  and  surely  inflict  the  fatal  wound,  under  the  pretense  of 
saving  his  own  life.  This  sort  of  proceeding  had  been  practiced 
with  success  three  different  times,  on  which  account  he  had 
spent  most  of  his  adult  life  in  prison,  and  before  his  term  ex- 
pires he  will  probably  die  in  his  cell.  He  described  tome  with 
evident  clearness,  and  certainly  with  considerable  self-satisfac- 
tion, the  details  of  his  proceedings,  and  manifested  no  evidence 
of  remorse  on  account  of  his  guilt.  The  cause  of  his  crime  on 
the  prison  docket  was  "  intemperance,"  and  he  was  willing  to 
accept  this  record  as  true,  because  it  was  written,  for  he  did  not 
appreciate  the  enormity  of  his  crime  nor  the  guilt  of  a  criminal. 


264  MEDICAL  JURISPRUDENCE. 

He  should  not  have  been  so  registered  He  is  not  a  drunkaro 
but  a  murderer  ;  the  criminal  intent  was  in  his  mmd  ;  the  ob- 
jects of  his  assaults  were  selected,  and  plans  laid  to  decoy  and 
irritate  them  before  he  drank  the  whisky  tc  aid  his  brutal  in- 
stinct and  nerve  him  for  the  fulfillment  of  his  diabolical  pur- 
pose. He  represents  a  class,  and  I  doubt  not,  if  a  careful  anal- 
ysis was  made  of  the  character  and  habits  of  convicts  now  in 
confinement,  the  discovery  would  be  made,  that  many  whose 
crime-cause  is  stated  to  be  intemperance,  would  be  found  io  be 
like  the  one  just  stated — temporary  drunkards  for  a  criminal 
purpose." 

Alcoholism  and  Civil  Action. — In  civil  cases  the  law 
is  not  so  stringent  as  in  criminal.  Habitual  drunkards  are  de- 
prived of  their  rights  by  commissions,  and  the  individual  Is  not 
liable  for  contracts  made  by  him. 

"  HaMtual  Drunkards." — Tt  is  a  difficult  matter  to  de 
termine  what  constitutes  ''  habitual  drunkenness  "  In  the  case 
of  Blsincyvs.  Blancy  (126  Mass.  Repts.,  20^),  a  decision  was  ren- 
dered in  an  action  for  divorce  on  the  ground  of  habitual  drunk- 
enness It  was  proved  •  that  defendant  for  12  or  15  years  past 
became  grossly  intoxicated  at  least  three  times  a  year  and  re- 
mained in  that  condition  from  7  to  10  days  each  time  that 
when  these  spells  came  he  was  rent  to  an  inebriate  asylum 
where  he  remained  until  they  passed  ;  that  l->etween  the  spells 
he  would  drink  nothing  but  that  any  excitement  would  make 
him  drink. 

Held,  on  appeal  to  the  Supreme  Court  that  this  was  sufficient 
proof  of  habitual  drunkenness. 

In  the  case  of  Wheeler  vs.  Wheeler  (53  Iowa>  511),  a  di- 
vorce was  granted  the  plaintiff  whc  was  the  victim  of  the  hus- 
band's violence  during  his  drunken  excesses,  although  at  other 
times  he  was  sober  and  was  able  to  conduct  his  business. 

Plaintiff  and  defendant  were  married  in  1859.  Previous  to 
that  time  defendant  was  addicted  to  liquor  and  was  frequently 
drunk.  After  his  marriage  he  became  an  habitual  drunkard  and 
his  wife  sued  for  a  divorce  on  that  ground  and  also  because  of 
inhuman  treatment.     The  divorce  was  granted. 

Although  he  was  always  sober  during  business  hours,  he  was 
habitually  drunk  at  other  times,  and  when  in  that  condition 
abused  his  wife,  calling  her  vile  names  and  openly  charging 
her  with  unchastity. 

On  appeal  the  Supreme  Court  affirmed  the  decree  of  divorce. 


ALCOHOLISM.  265 

Commitment  of  Drunkards. — The  commitment  of  an  in- 
ebriate may  often  Jead  to  very  disagreeable  results — the  medi- 
cal men  or  the  friends  being  sometimes  sued  by  the  person  im- 
prisoned. The  case  of  Jason  L.  Blodgett  reported  by  Dr. 
Fisher*  is  so  interesting  that  I  may  be  pardoned  for  referring 
to  it  rather  extensively,  using  the  doctor's  language. 

"  A  suit  was  brought  two  years  ago  in  the  Massachusetts  Su- 
preme Court  by  Jason  L.  Blodgett  against  his  divorced  wife, 
Major  Jones,  now  on  the  Board  of  Police  Commissioners  of 
Boston,  and  Drs.  Fisher  and  Youngman,  for  a  conspiracy  to 
imprison  him  in  the  Taunton  Lunatic  Hospital  on  the  false 
charge  of  insanity  ;  also  for  assault  and  battery  in  caus- 
ing his  arrest  ;  and  for  taking  his  property,  ruining  his  busi- 
ness, and  causing  great  damage  to  his  reputation  and  feelings  ; 
for  all  of  which  damages  to  the  extent  of  $15,000  were  claimed. 
His  legal  adviser  at  first  was  William  H.  Towne,  who  after- 
wards called  to  his  assistance  Edward  Avery.  The  defendants 
were  represented  by  Edward  P.  Brown.  At  the  first  trial  the 
plaintiff's  petition  was  dismissed  for  informality  and  illegal 
contents.  Major  Jones  was  excused,  as  having  had  nothing  to 
do  with  the  particular  commitment  complained  of,  the  plaintiff 
having  been  sent  to  Taunton  twice  ;  and  Mrs.  Blodgett,  having 
been  his  wife  at  the  time  of  the  alleged  offense,  could  not  be 
proceeded  against.  This  left  the  two  physicians  standing  alone  ; 
and,  after  six  months,  the  case  was  called  again,  unexpectedly, 
at  the  close  of  the  summer  vacation,  when  police  officers,  who 
were  important  witnesses,  were  absent.  The  wife,  whose  tes- 
timony was  almost  absolutely  essential  to  the  defense,  had  hid- 
den herself  from  her  divorced  husband  in  the  far  West,  and 
could  not  be  compelled  to  attend  or  obtained  as  a  witness 
without  great  expense.  The  plaintiff  told  a  story,  based  on  his 
confused  recollection  of  events,  and  deliberately  false  in  some 
parts,  which  was  contradicted  by  the  defendants,  who  o-ffered 
to  put  in  as  the  basis  of  their  certificate  information  received 
upon  '  due  inquiry,'  as  well  as  the  result  af  personal  exami- 
nation. This  hearsay  testimony,  though  required  by  law  as 
part  of  the  foundation  of  the  certificate,  was  not  admitted 
in  its  support  at  this  time,  and  the  wife  being  absent, 
essential  facts  were  kept  out  of  evidence.  The  rulings  of  Judge 
Endicott  were  in  every  other  way  favorable  to  the  defendants. 
The  jury  disagreed,  as  the  foreman  afterwards  stated  to  Major 
Jones,  by  permission  of  the  court, — nine    for    the    defendants 

♦  Boston  Med.  ^  Surg.  Journal,.''  Tune  6,  1881. 


266  MEDICAL    JURISPRUDENCE. 

and  three  for  the  plaintiff,  on  the  question  of  '  lack  of  due  in- 
quiry '  only.  No  suspicion  of  a  conspiracy  was  entertained  by 
any  juryman. 

"  The  case  was  again  called  last  spring,  the  wife  still  being 
absent.  The  plaintiff,  with  one  or  two  unimportant  exceptions, 
was  his  own  witness,  and  made  the  same  or  similar  false  state- 
ments as  before,  showing  clearly  on  the  stand  to  medical  ob- 
servation the  unreliable  and  irresponsible  nature  of  his  mental 
operations.  The  case  was  classified  as  dipsomania  on  all  the 
certificates  offered,  of  which  there  were  three.  The  following 
is  a  brief  sketch  of  the  plaintiff's  history  : — 

*■  At  the  time  of  the  trial  he  was  a  man  about  forty  years  of 
age,  of  evidently  neurotic  constitution,  impulsive,  excitable, 
with  a  loose  way  of  expressing  himself,  said  to  have  been  char- 
acteristic of  him  from  youth.  One  witness  testified  that  he 
had  always  been  given  to  telling  untruthful  and  inconsistent 
stories.  He  was  reported  to  have  had  an  aunt  who  was  insane. 
His  father  was  a  clergyman,  and  both  his  parents  died  in  his 
early  youth  of  consumption,  leaving  him  in  charge  of  his  rela- 
tives. He  was  a  bad  and  irregular  scholar,  though  quick- 
witted enough  for  mischief.  At  the  age  of  puberty  he  showed 
a  proneness  to  premature  vicious  conduct  of  various  kinds. 
He  is  said  to  have  begun  to  drink  by  sprees  at  the  nge  of  fifteen 
years.  He  had  some  good  traits  and  impulses,  but  was  early 
the  slave  of  his  appetites,  and  was  cursed  with  '  a  craving  for 
drink.  His  sister  says  he  was  a  good  brother  when  sober,  but 
a  '  perfect  devil'  when  drunk. 

"  He  was  in  frequent  trouble  on  account  of  his  scrapes,  both 
in  the  country  and  in  Boston,  until  the  war  broke  out, 
when  he  enlisted.  Having  previously  lost  the  sight  of  one  eye, 
it  was  still  further  injured  by  a  thorn,  and  was  enucleated.  He 
was  then  put  on  an  army  freight  train  as  conductor  or  brakeman, 
and  continued  to  serve  until  the  close  of  the  war.  After  the 
war  he  was  employed  on  railroads  at  the  West,  leading  a  life  of 
active  dissipatioi>,-  according  to  his  own  admission  to  a  witness. 
In  1875  l^s  came  to  Boston,  claiming  to  have  reformed,  and 
that  he  was  the  possessor  of  a  large  sum  of  money.  In  this  be- 
lief a  widow  of  the  former  proprietor  of  certain  Turkish  baths 
in  Boston — herself  being  the  owner  at  that  time — married  him. 
His  fortune  proved  mythical,  and  his  wife  was  obliged  to  pay 
for  his  wedding  suit  and  for  the  wedding  journey  ;  she  gave 
him  a  gold  watch,  and  supported  him  ever  afterwards,  except  for 
the  small  value  of  his  services  in  tlie  baths.  He  obtained  con- 
trol of  all  h.er  proj)erty,  and    in   a  very  short  time  developed  a 


ALCOHOLISM.  267 

tendency  to  drink  by  sprees,  in  which  he  was  ugly, 
violent,  and  dangerous,  threatening  his  wife  in  parti- 
cular. He  was  seldom  seen  drunk  in  the  ordinary  way,  but 
was  exalted  and  maniacal,  acting  more  or  less  au- 
tomatically, and  failing  to  remember  his  conduct  and 
conversation  afterwards.  It  is  but  charitable  to  suppose  that 
this  accounted  for  his  wholesale  denial  of  numerous  facts  testi- 
fied to  by  a  score  of  witnesses  on  the  stand.  In  a  year  or  two 
he  had  spent  all  his  wife's  property  and  destroyed  her  business 
by  his  drunken  conduct. 

"My  attention  was  first  called  to  him  October  12,  1875,  by 
Dr.  A.  N.  Blodgett,  his  wife's  physician,  but  not  related  to 
either  party.  Dr.  Blodgett,  being  in  attendance  on  the  wife, 
found  the  husband  in  a  state  of  delirium  from  drink,  in  which 
hallucinations  of  snakes  in  his  bed  were  prominent.  He 
thought  he  saw  the  devil  in  the  looking-glass  ;  threatened  to 
kill  his  wife  ;  threw  furniture  violently  about  the  room  ;  and 
did  not  recognize  Dr.  Blodgett,  but  violently  assaulted  him 
several  times.  Policemen  were  called,  and  he  was  taken  to 
the  tombs.  The  next  morning  application  was  made  by  Dr. 
Blodgett  to  the  Board  of  Directors  for  Public  Institutions  for 
his  commitment  to  Taunton  as  insane.  Having  learned  his 
previous  history,  I  agreed  that  he  iTiight  be  adipsomaniac,  but, 
the  present  attack  resembling  in  some  of  its  features  delirium 
tremens,  advised  that  he  should  be  sent  to  Deer  Island.  He 
did  not  have  a  perfect  attack  of  that  disease,  and  was  dis- 
charged in  two  or  three  days,  apparently  rational. 

"  He  was  again  arrested  January  31,  i876,for  violent  conduct 
while  drunk,  and  released  on  promise  of  good  behavior,  but 
was  re-arrested  the  same  day,  fined  three  dollars  and  costs  for 
being  drunk,  ten  dollars  and  costs  for  assault  on  a  female  em- 
ployed at  the  baths,,  and  was  bound  over  for  six  months  to 
keep  the  peace.  Was  sent  to  jail,  and  Major  Jones,  as  bail 
commissioner,  signed  the  bond  on  which  he  was  released. 
June  24,  1876,  was  arrested  again,  but  let  off  on  promise  of 
good  behavior.  Again  on  November  8,  1876,  he  was  arrested 
as  insane.  Complaint  having  previously  been  made  to  the 
board  of  directors,  I  was  sent  with  Dr.  Youngman  to  interview 
Blodgett.  Learned  that  he  had  been  very  violent  at  the  baths, 
smashing  up  furniture  and  frightening  bathers  and  employes. 
Found  him  at  home,  an  officer  bringing  him  up  from  the  cel- 
lar, where  he  liad  retreated,  having  an  ax  in  liis  hand.  His 
wife  had  fled  from  the  house,  and  the  other  inmates  were 
locked  in  their  rooms.     He  was  in  a  very  ugly,  sullen  mood, 


268  MEDICAL   JURISPRUDENCE. 

having  been  drinking  heavily.  He  denied,  as  was  his  custom, 
ever  drinking  to  excess  or  using  violence  to  any  one.  He  had 
recently  had  a  spasm  of  religious  interest  ;  went  into  a  prayer- 
meeting  at  the  Young  Men's  Christian  Association,  and  offered 
ai?y  brother  twenty-five  dollars  to  convert  him.  A  member 
went  home  and  prayed  with  him,  but  was  turned  out  by  Rlod- 
gett  because  he  '  didn't  pray  worth  a  damned  cent '  !  No  sign  of 
delirium  tremens  was  present  at  this  time,  and  it  was  determined 
to  send  him  to  Taunton  as  a  dipsomaniac,  with  a  view  to  a  suffi- 
ciently long  detention  for  his  improvement  or  cure.  He  made 
no  objection  and  asked  for  no  hearing,  thus  acquiescing  in  his 
commitment, 

"  Having  remained  at  Taunton  a  few  weeks,  he  was  discharged 
on  application  of  his  counsel,  Mr.  Towne,  and  was  sober  and 
well  behaved  for  a  considerable  period  after  it.  He  admitted, 
in  an  interview  with  Major  Jones,  his  irresistible  disposition  to 
drink,  and  that  he  presumed  the  allegations  of  violence  were 
true,  but  that-  he  did  not  remember  what  occurred  at  certain 
periods  of  his  drinking  spells.  He  had  also  consulted  a  rela- 
tive in  reference  to  some  cure  for  his  entire  loss  of  self-control 
in  reference  to  drink.  He  joined  the  church  of  which  his 
wife  was  a  member,  and  behaved  well  till  August,  1877.  From 
August  to  December  he  had  three  sprees,  in  which  his  conduct 
was  erratic  and  violent.  For  instance,  he  would  rush  down 
Washington  Street  in  the  evening  with  a  roll  of  bills  in  his 
hand,  flourishing  them  about,  and  followed  by  a  crowd  of  men 
and  boys.  He  would  buy  a  pie,  order  a  hack,  and  send  the  pie 
home  alone  in  the  hack.  On  several  occasions  he  used  vulgar, 
profane,  and  threatening  language  to  ladies  at  his  wife's  board- 
ing-house. December  10,  1S77,  complaint  having  been  made 
to  the  board  of  directors,  he  was  examined  at  his  boarding- 
house  by  Dr.  Youngman  and  myself.  We  found  him  in  bed, 
nervous  and  confused,  as  if  from  a  prolonged  debauch.  I 
talked  with  him  half  an  hour,  explained  to  him  my  theory  of 
his  case,  told  him  I  thought  nothing  but  prolonged  detention 
would  do  him  any  good  ;  that  as  he  had  improved  after  a  few 
weeks  in  Taunton  a  year  would  do  him  still  more  good.  He 
denied  drinking  more  than  was  good  for  him,  but  said  he  would 
stop  at  once  if  we  would  not  certify  in  his  case.  I  told  him  if 
he  was  arrested  again  for  violent  conduct  I  should  certify. 
This  interview,  he  testified,  was  only  a  few  minutes  long,  and 
AC  could  remember  but  one  thing  that  was  said.  Two  days 
after  he  was  arrested  at  the  baths  for  furious  conduct  towards 
his  wife  and  other  ladies,  and  for  trying  to  kick  over  a  hot  stove. 


ALCOHOLISM.  269 

He  was  sent  to  Taunton  December  12,  1877,  ^^^  asked  for  no 
hearing  at  this  time. 

"  Remaining  in  Taunton  about  three  months  and  a  half,  he  was 
discharged  March  26th,  and  rearrested  for  throwing  a  bottle  at 
some  one  at  the  baths  March  30th,  four  days  after.  The  next 
morning  he  showed  very  little  effect  from  liquor  when  seen  at 
the  tombs,  the  period  of  indulgence  having  been  brief.  He 
demanded  a  hearing  at  once,  and  a  certificate  pro  forma  hav- 
ing been  signed  to  bring  his  case  before  Judge  McKim,  he  was 
released  on  promising  good  behavior.  In  April  a  libel  for 
divorce  was  filed  by  his  wife,  alleging  brutal  and  violent  con- 
duct, with  gross  and  frequent  intoxication.  Blodgett  appeared 
in  the  anteroom  of  the  supreme  court  in  his  usual  peculiar  con- 
dition, insulted  several  ladies  there  with  obscene  talk,  undertook 
to  conduct  his  own  defense,  and  harangued  the  court  in  such 
strange  and  familiar  language  that  the  judge  told  him  he  must 
be  either  drunk  or  crazy,  and  granted  the  divorce.  His  wife 
then  left  him  for  the  West,  in  a  penniless  condition,  and  he 
soon  found  a  lawyer  willing  to  take  his  suit  against  the  alleged 
conspirators.  This  idea  of  a  conspiracy  was,  I  think,  in  part, 
a  vague  delusion  growing  out  of  imaginary  wrongs,  and  in  part 
a  foolish  attempt  to  rehabilitate  his  fortunes  and  revenge  him- 
self at  the  same  time  by  a  suit  against  his  assumed  enemies.  A 
few  weeks  before  the  final  trial  he  was  arrested  for  drunkenness 
in  Waltham,  and  boasted,  in  his  loose  way,  of  the  immense  busi- 
ness he  was  doing,  and  the  money  he  was  going  to  make  out  of 
the  doctors. 

"  At  the  last  trial,  before  Judge  Lord,  the  preceding  facts  and 
many  others  of  similar  import  were  proven.  Twenty  police- 
men testified  to  Blodgett's  habits  of  drunkenness,  eccentricity, 
and  to  his  violent  actions.  They  all  agreed  that  he  was  different 
from  ordinary  drunkards  in  his  talk  and  conduct,  and  was  regard- 
ed as  crazy  and  dangerous  when  in  liquor.  This  opinion 
was  sustained  by  many  sober  witnesses  who  knew  him  well, 
and  by  his  own  confessions  to  Major  Jones,  as  well  as  his  appear- 
ance on  the  stand.  He  there  denied  in  a  wholesale  way  all 
excessive  drinking  and  all  acts  of  violence,  only  to  be  contradic- 
ted by  many  reliable  witnesses.  He  might,  perhaps,  truly  have 
said  that  he  remembered  no  acts  of  violence,  as  I  have  no  doubt 
his  conduct  was  automatic.  Judge  Lord  allowed  the  facts  ob- 
tained by  '  due  inquiry'  to  be  testified  to  in  full,  the  other  side 
failing  to  object. 

"  A  number  of  experts  were  called  by  the  defense  Drs.  Walker, 
Brown,  Gage,    Russell,  Denny,  Jelly,  Folsom,  Channing,   Day, 


270  MEDICAL   JURISPRUDENCE. 

Blodgett,  Fisher  and  Youngman,  gave  their  definitions  of  dip- 
somania and  testified  to  the  propriety  of  treating  it  in  hospitals 
for  the  insane,  in  the  absence  of  other  special  institutions. 
These  gentlemen  substantially  agreed  \n  affirming  the  existence 
of  such  a  disease  and  in  the  necessity  of  so  treating  it. 

"  The  plaintiff  called  on  his  behalf  Drs.  Henry  G.  Clark,  J.  P. 
Treadwell,  and  Horace  Chase.  Dr.  Clark  thought  a  dipso- 
maniac must  be  a  person  who  on  drinking  a  single  glass  must 
inevitably  go  on  to  complete  intoxication.  He  thought  Blodgett 
did  not  fall  within  this  definition.  He  was  obliged  to  admit, 
however,  that  he  had  recently  said  that  Blodgett  was  'crazy 
drunk  '  and  properly  sent  to  Taunton,  but  was  kept  too  long  ; 
and  that  he  had  certified  within  three  months  in  the  case  of  a 
dangerous  dipsomaniac  committed  to  Danvers.  Dr.  Treadwell 
gave  his  views  at  length,  and  thought  the  part  of  the  testimony 
he  had  heard  did  not  warrant  calling  Blodgett  a  dipsomaniac. 
Dr.  Chase's  testimony  I  did  not  hear. 

"  Judge  Lord's  charge  to  the  jury  was  satisfactory  in  every 
way  to  the  defense,  and  was  an  admirable  statement  of  the 
rights  and  liabilities  of  physicians  certifying  in  cases  of  insanity. 
It  deserves  reproduction  as  a  whole,  but  I  will  give  only  a  very 
brief  abstract  of  it.  Judge  Endicott  had  said  in  substance  at 
the  previous  trial  that  it  was  evident  from  the  testimony  that 
there  was  such  a  disease  as  dipsomania  ;  that  the  line  between 
it  and  ordinary  vicious  drinking  was  a  narrow  one,  which  only 
qualified  medical  men  could  safely  draw  ;  and  that  a  lunatic 
hospital  was  a  proper  place  for  its  treatment.  Judge  Lord, 
however,  told  the  jury  to  reject  the  technicalities  of  the  doctors, 
and  charged  that  if  mental  unsoundness  of  any  kind  existed  it 
was  an  end  of  the  case  ;  that  if  physicians  honestly  believed 
the  party  to  be  insane,  although  they  may  have  been  misled  or 
mistaken,  they  were  not  responsible.  They  were  obliged  by 
law  to  make  "due  inquiry"  of  the  jjarties  most  likely  to  possess 
the  facts  relating  to  insanity,  and  nearest  by  ties  of  relation- 
ship or  affection  to  the  patient ;  but  ihey  could  not  take  sworn 
evidence  in  the  case,  and  must  act  according  to  their  best  judg- 
ment upon  the  facts  obtainable.  Their  certificate  was  not  re- 
quired by  law  to  be  under  oath,  and  was  merely  the  necessary 
means  of  bringing  the  case  into  tht  jurisdiction  of  the  proper 
court,  after  which  they  were  not  resi)onsible  for  the  action  of 
the  court,  unless  it  could  be  shown  that  they  willfully  gave  false 
testimony,  or  grossly  and  criminally  neglected  to  incpiire  into 
the  facts  of  the  case.  In  the  words  ot  the  court,  'If  capable 
physicians  should  act  recklessly,  disregarding  the  rights    of   the 


Alcoholism.  ijt 

party,  and  send  him  off  to  a  hospital  without  any  evidence  at  all, 
then  they  would  be  responsible.  But  if,  on  the  other  hand, 
they  made  the  inquiry  which  the  circumstances  of  the  particu- 
lar case  called  for,  then  although  subsequent  events  may  show 
that  that  inquiry  might  have  been  pursued  further,  if  they 
acted  in  good  faith,  that  is  their  protection.'  The  jury  return- 
ed a  verdict  for  the  defendants." 

So  far  as  the  making  of  contracts  is  concerned  the  law  does 
not  interfere  when  there  is  rational  consent,  but  when  the 
drunkard  is  in  such  a  condition  when  he  makes  a  contract 
having  no  intelligent  idea  of  what  he  is  doing,  such  a  contract  en- 
tered into  by  him  cannot  be  considered  valid  or  binding.  Mar- 
riages made  when  the  individual  is  utterly  unconscious  of  what 
he  is  doing,  are  of  course  null  and  void. 

Testamentary  Capacity. — The  will  of  a  confirmed  drunk- 
ard will  stand  in  law,  provided  the  person  who  made  it  is  not  in  a 
condition  to  be  so  unreasonable  and  irrational  as  to  be  unable  to 
exercise  any  thing  like  healtliy  judgment.  A  man  may  be  a  hard 
drinker,  and  make  the  will  after  a  debauch,  but  unless  its  char- 
acter is  so  absurd  as  to  betray  mental  unsoundness  he  cannot 
be  reasonably  deemed  irresponsible.  In  a  recent  case  in  which 
I  appeared,  the  testator  was  a  man  of  bad  habits,  who  drank  im- 
moderately and  steadily.  Evidence  was  produced  to  prove  that 
he  had  done  all  manner  of  foolish  things  before  and  after  the 
will  was  made,  but  no  evidence  was  brought  forward  to  show 
that  at  the  time  the  paper  was  signed  the  testator  was  in  any 
condition  to  prevent  him  from  fully  knowing  the  nature  of 
what  he  was  doing. 

We  are  to  consider  in  such  cases  the  degree  of  the  drunken- 
ness, the  habits  and  physical  condition  of  the  person. 

The  will  of  a  man  of  bad  habits  is  often  contested,  it  being 
asserted  that  his  alcoholic  dissipation  renders  him  incom- 
petent. But  though  an  individual  may  be  outrageous  in 
his  ordinary  conduct,  a  great  deal  more  is  required  than 
these  exhibitions  to  indicate  that  he  has  not  the  power  of 
mind  to  make  a  will.  Such  a  case  fell  under  my  notice 
two  or  three  years  ago,  the  testator  being  a  man  of  mid- 
dle age,  who  had  for  months  been  addicted  to  drinking, 
although  in  a  periodical  way.  A  vague  history  of  bad  temper, 
broken  sleep  and  many  extravagant  acts,  none  of  which,  how- 
ever, were  necessarily  manifestations  of  insanity,  were  testified 
to  by  the  contestants,  and  one  physician  gravely  asserted  that 
a  proof  of  his  mental  perversion  consisted  in  the  irritability  of 


272  MEDICAL   JURISPRUDENCE, 

his  throat  during  the  time  he  was  making  medicated  applica- 
tions to  the  same.  He  was  alleged  to  have  declared  that  "  he 
could  not  retain  any  thing  upon  his  stomach,"  that  "  he  resorted 
to  memoranda  that  he  should  not  neglect  his  engagements," 
that  "  he  abused  the  doctor  who  had  treated  his  wife  during 
her  last  illness,  and  threatened  him  with  violence,"  that  "  he  com- 
plained of  being  homesick  ;"  and  various  persons  who  had  seen 
little  of  the  testator  testified  to  having  observed  him  drunk  on 
several  occasions  ;  that  "  he  was  extravagant,  and  bought  large 
quantities  of  oranges,"  which,  however,  were  for  his  sick  wife  ; 
and  that  he  "  talked  wildly  about  his  business."  It  appeared,  on 
the  other  hand,  that  he  was  able  to  attend  to  his  affairs  for  some 
time  before  his  death  which  was  not  due  to  alcoholism;  that  when 
he  made  his  will  it  was  at  a  time  between  two  of  his  sprees, 
and  that  there  was  no  want  of  sagacity  or  any  irregularity 
shown  in  the  disposition  of  his  property.  In  this  case,  as  in 
many  others,  the  popular  ideas  of  insanity  are  apt  to  be  thor- 
oughly ventilated,  and  it  is  strange  that  this  kind  of  testimony 
should  receive  any  attention  whatever  in  courts  of  law.  It  is  a 
very  easy  matter  to  exaggerate  the  disorderly  behavior  of  an  indi- 
vidual who  is  in  no  sense  insane.  The  "  excitement  "  alluded 
to  by  interested  witnesses  is  probably  nothing  more  than  a  mod- 
erate emotional  exhilaration,  and  the  business  schemes  which 
attract  the  wonderment  of  those  who  wish  the  will  broken, 
ordinarily  display  a  mind  of  unusual  shrewdness.  The  specu- 
lations nearly  always  turn  out  well,  and  the  despondency  does 
not  rise  above  the  dignity  of  an  ordinary  attack  of  the  blues.  In 
the  above  case  the  husband's  devotion  to  his  dying  wife 
seemed  to  have  astonished  those  persons  who  appeared 
upon  the  side  of  the  contestants  ;  and  this  peculiar  behavior, 
which  was  regarded  by  them  as  evidence  of  mental  unsound- 
ness, consisted  in  such  kindly  offices  as  removing  her  to  the 
window,  so  that  she  might  get  the  fresh  air,  and  bringing  her 
fruit  ;  and  though  his  exuberation  of  affection  might  have  been 
that  which  is  so  often  intensified  by  occasional  libations,  it  was 
in  this  case  nothing  unusual.  It  did  not  appear  that  there  was 
any  thing  in  the  character  of  the  will  that  indicated  insanity  ; 
that  it  was  legally  witnessed,  and  made  at  the  time  when  the  in- 
dividual was  perfectly  sober,  and  was  therefore  very  properly 
admitted  to  probate. 

In  another  case  of  a  different  kind,  the  patient  had  for  sev- 
eral years  indulged  in  large  quantities  of  alcohol,  and  it  was 
common  for  him  to  shut  himself  up  in  the  room  with  a  box  of 
champagne   and  not    leave    until  he  had  recovered  from  the 


ALCOHOLISM,  273 

effects  of  the  intoxication  produced  by  the  dozen  bottles  he 
finished  one  after  the  other  in  rapid  succession.  This  man  for 
several  years  before  his  death  drank  all  kinds  of  liquors  to  ex- 
cess, squandered  his  money,  giving  large  amounts  to  persons 
who  had  little  or  no  claim  upon  him,  and  betrayed  a  change  in 
character  which  was  remarkable  when  contrasted  with  the 
regularity  and  sobriety  of  previous  years.  Within  a  short  time 
before  his  death  he  manifested  symptoms  of  the  inevitable  dis- 
eases which  are  due  to  excesses  of  this  kind,  and  he  finally  suc- 
cumbed to  cirrhosis  and  died  comatose.  When  supported  in 
bed  and  surrounded  by  those  to  whom  he  left  his  money,  he 
made  a  will  and  died  a  few  hours  afterwards.  This  will  was 
very  properly  contested  by  his  brother,  and  it  was  admitted  to 
probate  by  the  Surrogate,  though  the  decision  of  the  latter  was 
subsequently  reversed.  It  is  quite  likely  here  that  the  man's 
mental  condition  was  one  which  even  some  time  before  his  de- 
mise would  prevent  him  from  properly  recognizing  the  objects 
of  his  bounty,  and  render  him  an  easy  prey  to  designing 
persons  ;  but  a  will  made  under  more  outrageous  circumstances 
it  is  difficult  to  conceive  of,  for  he  was  literally  in  a  condition  of 
extremis  when  his  name  was  signed  to  the  document. 


Case  LIV. — Alcoholic  Insanity  with  General  Delusions 
Not  Affecting  Testamentary  Capacity. 

Lee      ) 

vs.        |-3i  N.  J.  Equity  Reports,  d^iZ' 
Scudder,  ) 

Betsy  Marsh  died  April  7,  1876,  aged  65  years.  She  was 
eccentric  in  dress  and  coarse  in  language.  She  died  after  a 
short  illness,  of  a  disease  of  the  brain,  not  determined,  which 
gave  rise  to  frequent  delusions.  These  delusions  only  appeared 
occasionally.  On  the  3d  of  April,  1876,  she  executed  her  will, 
and  stated  in  answer  to  a  question  that  she  knew  what  she  was 
doing,  and  later  in  the  same  day  sent  for  a  Dr.  Kinch,  who  had 
drawn  her  will,  to  make  some  alterations  in  it.  These  altera- 
tions were  never-made,  for  the  next  day  she  was  found  intoxi- 
cated in  the  woods,  and  from  that  time  she  was  very  ill  until  she 
suddenly  died  on  the  7th  of  April.  It  was  testified  that  de- 
ceased was  of  sound  mind  at  the  time  the  will  was  executed  ; 
that  her  delusions  were  only  intermittent,  resulting  from  her 
disease,  and  that  they  consisted  of  presentiments  of  death,  and 


274  MEDICAL   JtTRISPRUDENCE. 

did  not  relate  to  any  person  who  might  have  been  an  object  ot 
her  bounty. 

The  will  was  admitted  in  the  Union  County  Orphans  Court, 
and  on  appeal  to  the  Prerogative  Court  this  action  was  affirmed. 

In  chronic  alcoholism  with  organic  brain  diseases  the  question 
of  responsibility  naturally  arises.  In  most  cases  of  advanced 
structural  disease  the  character  of  the  testator  undergoes  a 
series  of  changes  which  render  him  weak,  vacillating,  childish 
and  without  vigorous  memory.  At  such  times  it  is  extremely 
probable  that  the  patient  is  a  prey  to  designing  relatives,  and 
suffers  enfeeblement  of  the  will. 

Care  should  be  taken  not  to  confuse  the  mental  impairment 
of  old  age  or  eccentricity  with  the  peculiarities  of  disposition 
and  habits  resulting  from  chronic  alcoholism. 

Alcoliolism  and  Life  lusuraiice. — Litigations  frequently 
arise  between  life  insurance  companies  and  the  heirs  of 
deceased  persons  who  have  either  drunk  to  excess  or  who  have 
died  from  alcoholism.  In  most  of  the  policies,  there  is  a  clause 
which  explicitly  states  that  excessive  indulgence  in  alcohol  or 
any  drug  that  tends  to  materially  shorten  life  must  vitiate  the 
contract.  In  some  instances  the  patient  withholds  his  bad  hab- 
its from  the  company,  in  others  the  formation  of  the  bad  habit 
arises  sometimes  after  the  application  for  the  policy  ;  and  again 
the  question  of  heredity  arises,  and  the  patient  makes  his  dec- 
laration entirely  ignorant  of  any  family  taint  or  predisposition 
to  drink.  It  sometimes  happens  that  policies  are  transferred, 
and  the  individual  subsequently  drinks  himself  to  death — thus 
inflicting  a  loss  upon  the  assignee,  and  perhaps  giving  rise  to  a 
suit  brought  against  his  executors.  The  question  of  alcoholic 
indulgence  in  this  connection  gives  rise  to  a  number  of  possi- 
bilities. The  individual  may  be  a  hard  drinker  and  yet  show 
no  signs  of  drunkenness,  and  may  drink  to  excess,  and  pre- 
sumably to  a  degree  to  shorten  life,  still  it  will  be  exceedingly 
difficult  to  prove  this. 

Several  English  companies  refused  to  pay  premiums  to  the 
families  of  hard  drinkers,  and  in  court  the  family  were  able  to 
show  that  the  decedents  had  never  been  thought  drunk.  When 
asked  to  define  drunkenness,  the  Judge  stated.it  was  a  state  in 
which  a  man  loses  his  reason  and  the  use  of  his  legs,  and  is 
incapable  of  responding  to  questions  when  addressed.  This  is 
a  most  general  definition,  when  we  bear  in  mind  thevariety  of 
conditions  in  which  the  same  state  of  affairs  exist. 


CHAPTER  VI. 


SUICIDE. 


Medico-Legal  Questions  Arising  in  Connection 
therewith. — The  medical  man  is  often  expected  to  make  ex- 
aminations of  dead  bodies  and  to  testify  in  court  in  regard  to 
suicide,  and  the  duty  is  by  no  means  a  light  one,  for  it  may  in- 
volve very  serious  responsibilities.  The  question  that  may 
arise  is,  whether  suicide  or  homicide  has  been  comiritted. 
He  is  also  called  upon  to  consider  cases  of  life  insurance  ; 
for  it  is  not  uncommon  nowadays  for  persons  to  insure 
in  heavy  amounts,  and  then  make  away  with  themselves,  so 
that  their  families  may  be  provided  for,  or  their  creditors  may 
be  paid.  In  a  class  of  cases,  which  must  hereafter  arise  in 
greater  numbers  than  they  Mready  have  in  the  courts,  it  be- 
comes our  function,  since  the  laws  are  so  strict  in  regard  to 
the  punishment  of  would-be  suicides,  to  pronounce  upon  the 
responsibility  of  the  individual  who  has  been  arrested  while 
making  an  unsuccessful  attempt  to  do  away  with  himself.  In 
such  examples  as  the  life  insurance  cases,  the  question  of  in- 
sanity comes  up,  and  we  are  to  decide  the  criminal  and  civil 
obligations  that  may  be  submitted  to  us  in  court,  so  far  as  the 
mental  condition  of  the  suicide  is  concerned. 

Principal  Modes  of  Death. — Under  the  first  head  ; 
namely,  cases  in  which  a  doubt  exists  whether  the  crime  should 
be  designated  suicide  or  homicide,  it  behooves  us  to  carefully 
investigate  the  mode  and  cause  of  death  ;  the  presence  of 
wounds  or  contusions,  and  the  situation  of  such  injuries  ;  the 
question  also  arises  whether  the  wounds  were  inflicted  perhaps 
on  a  body  already  dead  for  the  purpose  of  directing  sus- 
picion and  baffling  detection.  In  cases  of  drowning  the  evi- 
dences of  a  possible  struggle  must  be  looked  for,  and  regard 
should  be  paid  to  the  place  chosen  for  the  deed.  Where  death 
has  been  brought  about  by  poison,  we  are  to  determine  the 
character  of  the  poison  used,  and  its  effects  in  point  of  time  as 
contrasted  with  the  evidence  of  those  who  last  saw  the  patient 


276 


MEDICAL    JURISPRUDENCE. 


alive.  We  are  also  to  ascertain  the  possible  motive  of  the  sup- 
posed suicide,  his  relations  to  his  family,  and  in  fact  all  the  cir- 
cumstances of  the  individual's  life. 

Wounds  Inflicted  Iby  Suicides. — The  wounds  made  by 

the  suicide  are  rarely  incised,  and  stabbing  is  very  uncommon. 
The  exception  however  to  this  rule  is  where  the  method  has 
been  throat-cutting  ;  and  it  is  exceedingly  difficult  to  differ- 
entiate the  wounds  that  have  been  inflicted  by  a  murderer  or 
a  suicide  ;  both  may  be  made  with  the  razor,  and  by  the 
latter  such  is  usually  the  case.  In  both  instances  there  are  a 
series  of  preliminary  cuts,  known  as  tentative,  which  are  to  be 
found  at  the  place  of  commencement  of  the  major  incision. 

Direction  of  the  Wound. — We  are  to  determine  in 
doubtful  cases  the  side  of  the  neck  at  which  the  wound 
starts,  and  we  are  generally  able  to  detect  the  beginning,  the 
center,  and  termination  of  the  incision  by  the  varying  depth. 
Ogston  states  that  the  commencement  of  the  incision  has  but 
one  point,  while  the  latter  part  ends  in  a  bifurcation  or  several 
divisions.  The  tentative  cuts,  as  I  have  said,  are  those  which 
may  be  found  near  the  commencement  of  the  wound,  and  do 
not  connect  with  the  large  incision' but  may  be  superficial,  and 
above  or  below  it.  The  deepest  part  of  the  wound  is  usually 
at  the  commencement. 


F!c.  fi. 

Suicid.nl  Cut-'l'liroat. 

(Ocston.) 


It  is  important  in  cases  of  suicide  to  notice  that  the  wcunc 


SUICIDE.  277 

usually  runs  from  left  to  right,  except  in  rare  cases  where  the 
patient  is  left-handed  ;  while  the  reverse  is  ordinarily  the  case 
in  murderous  wounds. 

As  a  rule  it  may  be  assumed  that  in  wounds  of  the  throat 
inflicted  by  suicides,  especially  those  who  know  nothing  of  the 
anatomy  of  the  parts,  the  point  of  commencement  of  the  wound 
is  usually  higher  than  the  termination.  It  is  often  difficult, 
however,  to  determine  this  question  with  any  degree  of  cer- 
tainty, and  curious  instances  are  brought  forward  in  which 
suicidal  attempts  have  been  made  not  only  by  left-handed, 
persons,  but  by  those  who  held  a  knife  in  each  hand  and  make 
a  double  wound.  In  such  a  case  as  the  latter,  of  course,  we 
would,  under  ordinary  circumstances,  be  utterly  powerless  to 
speak  with  any  measure  of  positiveness. 

Number  of  Wounds. — In  suicidal  cut-throat  there  is  usu- 
ally more  than  one  wound,  and  this  is  more  frequently  so 
either  in  timid  persons  or  those  who  are  more  or  less  under  the 
influence  of  drink,  and  this  is  apt  to  be  the  case  although  a 
man  may  be  wrought  up  to  steadiness  with  alcohol  and  may 
make  a  deep  unwavering  cut. 

Casper  relates  the  following  cases  in  which  the  difficulties  in 
judging  of  the  character  of  a  wound  by  the  direction  are  shown  : 
*'  Upon  one  and  the  same  day  we  dissected  the  bodies  of  two 
men,  one  21  years  of  age  and  the  other  50,  both  of  whom  were 
well  known  to  have  killed  themselves  by  cutting  their  throats 
with  a  razor,  the  former  three  and  the  latter  two  days  previ- 
ously. I  relate  these  two  cases  because,  in  the  first  place, 
although  they  were  both  indubitably  cases  of  suicide,  yet  the 
wounds  were  perfectly  horizontal,  so  that  it  was  perfectly  impossi- 
ble to  say  where  the  wounds  had  commenced  and  where  they 
ended.  Further,  there  was  this  peculiar  circumstance  in  relation 
to  the  body  of  the  older  man,  that  even  the  hands  had  been 
washed  before  it  came  before  us  for  examination,  and  in  respect 
of  the  younger  man,  that  his  left  hand  was  completely  besmeared 
with  b'ood,  the  right  much  less  so  ;  further  that  the  left  hand 
was  quite  spasmodically  contracted,  the  right  not.  These  ap- 
pearances induced  us  to  suppose  that  the  incision  must  have 
been  made  with  the  left  hand,  and  this  supposition  was  subse- 
quently ascertained  to  be  correct  by  the  inquiries  of  the  police." 

Homicide  Distinguished  from  Suicide. — In  these  cases, 
also  related  by  Casper,  the  evidences  of  homicidal  acts  are 
distinguished  from  those  of  a  suicidal  character  :  "  Some  time 
back  the  body  of  a  man  was  found  lying  on  the  high-road.    The 


278  MEDICAL   JURISPRUDENCE. 

throat  was  severely  cut,  and  he  had  evidently  died  from  hemor- 
rhage. A  bloody  knife  was  discovered  at  some  distance  from  the 
body  ;  and  this,  together  with  the  circumstance  of  the  pockets  of 
the  deceased  having  been  rifled,  led  to  a  suspicion  of  murder. 
This  idea  was  confirmed  when  the  wound  was  examined.  It 
was  cut,  not  as  is  usual  in  suicide,  by  carrying  the  instrument 
from  before  backwards,  but  as  the  throats  of  sheep  are  cut.  The 
knife  had  passed  in  deeply  under  and  below  the  ear,  and 
had  been  brought  out  by  a  semi-circular  sweep  in  front,  all 
the  great  vessels  of  the  neck,  with  the  oesophagus  and 
trachea  having  been  divided  from  behind  forwards.  The 
nature  of  the  wound  at  once  rendered  it  improbable  that  it 
could  have  been  self-inflicted  ;  and  it  further  served  to  de- 
tect the  murderer,  who  was  soon  afterwards  discovered,  and 
executed." 

"  With  reference  to  the  extent  of  the  wound,  the  cele- 
brated Earl  of  Essex's  case  has  often  been  quoted.  He 
was  found  dead  in  the  Tower  in  1683,  and  it  was  the 
generally  received  opinion  that  he  had  been  murdered  by  per- 
sons hired  by  the  Duke  of  York,  afterwards  King  James  II. 
Upon  examining  the  wound,  it  was  found  that  the  jugular 
vessels,  trachea,  and  oesophagus,  were  cut  through  to  the 
very  neck-bone.  The  verdict  was  suicide.  In  1688  the 
matter  was  revived,  and  before  a  committee  of  the  House  of 
Lords,  it  was  proved  that  the  razor  which  the  wound  was  in- 
flicted was  found  on  the  left  side  of  the  body,  while  it  was 
known  that  the  Earl  was  left-handed.  The  edge  of  the  razor 
was  found  notched  ;  and  it  was  also  proved  that  the  cravat 
worn  by  the  deceased  was  cut  through,  and  his  right  hand 
was  wounded  in  five  places. 

"  The  committee  made  no  report.  Lord  Delamare  under- 
took to  draw  it  up,  but  before  he  did  so.  Parliament  was 
prorogued.  Bishop  Burnet,  who  has  given  the  particulars  of 
the  case  with  great  minuteness,  says  he  had  no  doubt  that  the 
Earl  of  Essex  committed  suicide.  He  was  subject  to  fits  of 
deep  melancholy,  and  maintained  the  lawfulness  of  suicide." 

Location  of  the  Suicidal  Wound. — The  location  of 
the  suicidal  wound  is  a  matter  of  a  great  deal  of  importance. 
It  is,  of  course,  unlikely  that  the  back  would  be  found  to  be 
the  site  chosen,  while  writers  uj)on  medical  jurisprudence  gen- 
erally admit  that  the  suicide  very  rarely  inflicts  a  wound  upon 
the  left  side  of  the  body.  Self-inflicted  injuries  are  usually 
upon  the  front  of  the  body. 


SUICIDE.  279 

Seat  of  Wounds. — The  suicide  IS  very  apt  to  choose 
certain  situations  which  would  not  naturally  be  selected  by  the 
murderer  for  the  infliction  of  violence.  Thus  we  find  that  they 
very  often  place  the  muzzle  of  the  pistol  into  the  mouth,  or 
fire  so  that  the  ball  passes  evenly  through  either  temple.  They 
select  the  most  vulnerable  or  vital  point.  Pistol  wounds  are 
very  rarely  made  by  suicides  in  other  parts  than  the  head,  ex- 
cepting, perhaps,  the  region  of  the  heart.  But  the  murderer, 
if  he  selects  the  head,  usually  fires  from  behind  ;  or  if  he  aims 
at  the  trunk  his  ball  enters  at  some  point  where  the  suicide 
would  never  think  of  wounding  himself,  or  perhaps  where  he 
could  not  if  he  would. 

Contusions  Unusual. — Contusions  are  very  rare  among 
suicides,  unless  they  be  due  to  injuries  received  just  after  the 
fatal  act  has  been  committed  ;  as  when  the  victim  falls  upon 
the  rocks  or  from  a  height ;  but  under  such  circumstances  no 
reasonable  doubt  can  be  entertained  as  to  their  origin  and  na- 
ture, for  they  are  not  in  situations  where  they  undoubtedly 
would  be  if  self-inflicted.  Of  course,  reasonable  doubt 
may  sometimes  arise  when  different  sides  of  the  arms  or 
legs  or  irregular  parts  are  conjointly  injured,  where  there  has 
been  a  fall.  In  multiple  injuries  inflicted  by  an  assailant  there 
will  be  some  regularity  in  the  distribution  of  the  contusions. 
It  has  been  said  by  Ogston  that  very  severe  contusions  by  such 
weapons  as  an  ax  or  hammer,  or  some  other  ponderous  instru- 
ment, are  more  often  suggestive  of  murder  than  suicide,  and  it 
is  impossible  to  arrive  at  any  conclusion  as  to  their  being  due 
either  to  suicide  or  accident. 

Position  of  tlie  Weapon. — The  presence  of  a  weapon, 
either  in  the  hands  of  a  suicide  or  near  him,  strengthens  the 
probability  of  a  self-perpetrated  crime  ;  though,  as  we  all  know, 
the  pistol  may  be  placed  in  this  position  by  a  cunning  murderer 
to  conceal  his  act.  In  the  suicide  we  will  probably  discover  a 
spastic  contraction  of  the  fingers  or  a  naturalness  in  their  po- 
sition which  could  not  be  arranged  or  effected  by  another  per- 
son. So,  too,  it  sometimes  happens  that  the  suicide  provides 
himself  with  a  gun,  and  his  position  with  reference  to  the  instru- 
ment may  settle  the  question  of  self-murder.  Concealment  of 
the  body,  removal  of  the  weapon,  or,  as  it  occasionally  has 
happened  the  placing  of  a  weapon  near  the  body  in  such  a 
position  that  the  suicide  could  not  have  reached  it,  or 
where  he  could  not  have  thrown  it„  suggest  homicide  most 
Gtrongly. 


28o  MEDICAL   JURISPRUDENCE. 

Accomplislimeiit  of  Suicide  by  Men  and  Women.— 

Men  and  women  commit  suicide  in  different  ways.  It  is  quite 
rare  to  find  a  woman  who  has  shot  or  stabbed  herself.  We  do, 
however,  find  that  if  the  self-inflicted  wound  has  been  made  by 
her,  it,  as  a  rule,  consists  in  the  o])ening  of  a  vein  with  a  pen- 
knife or  pair  of  scissors,  or  some  small  weapon.  Women  usu- 
ally make  away  with  themselves  by  poison  or  by  drowning,  or, 
rarely,  by  hanging  ;  while  men  in  many  cases  seek  the  pistol, 
razor  or  the  knife. 

Suicide  by  Drowning. — Suicide  by  drowning  is  a  quite 
common  method,  and  we  are  very  often  required  to  distinguish 
between  accidental  and  suicidal  death. 

In  cases  where  murder  has  been  committed  it  is  a  somewhat 
commoin  occurrence  to  find  that  the  victim  has  first  been  mur- 
dered and  the  body  then  t'  r">wn  into  the  water  for  the  pur])ose 
of  giving  the  impression  that  the  victim  has  taken  his  own  life. 
In  this  case  if  the  body  bears  wounds,  we  are  to  determine  whe- 
ther such  wounds  are  post-mortem  or  if  they  have  been  pro- 
duced just  before  death  ;  in  the  latter  case  an  assault  will  be 
suggested. 

Multiple  Attempts. — In  rare  instances,  however,  suicides 
have  been  known  to  stab  or  shoot  themselves  before  resorting 
to  the  water  ;  but  here  we  will  often  find  that  the  situation  of 
the  injury  is  inconsistent  with  murder,  and  it  is  probable  that 
the  pistol  or  knife  wmII  be  found  near  the  body  of  the  victim. 
Post-mortem  wounds  are  usually  of  a  character  which  suggests 
the  improbability  of  self-infliction.  Violence,  such  as  a  fall 
upon  the  rocks,  or  that  which  would  occur  as  a  consequence 
of  the  body  being  dashed  against  a  dock  or  crushed  beneath 
shipping,  will  sometimes  produce  quite  suspicious  cuts  and 
blows.  Ogston  refers  to  a  double  dislocation,  resulting  from 
forcible  contact  with  the  bottom  of  a  large  ship,  the  body  having 
been  in  the  water  some  time.  In  other  cases  of  this  kind 
we  usually  find  multiple  injuries,  for  the  severe  force  that 
produces  such  a  notable  accident  would  give  rise  to  'minor  frac- 
tures and  dislocations  as  well.  Ogston  also  relates  an  instance 
where  a  female  suicide  received  a  laceration  of  the  perineum 
by  the  forcible  separation  of  the  thighs  on  coming  in  contact 
with  the  water.  The  collision  with  some  obstacles  in  his  way, 
when  falling  into  the  water,  may  also  cause  formidable  injuries, 
which  may  be  imputed  to  violence  the  victim  has  received  at 
the  hands  of  nnotiicr  i)crson. 

Deliberate   Preparations  —  Rope   Tying.  —  Suicides 


SUICIDE.  281 

sometimes  tie  themselves  up  so  that  their  attempt  shall  not 
miscarry,  and  this  may  perhaps  suggest  when  the  body  is  found 
that  a  homicide  rather  than  a  suicide  has  been  committed. 
Such  a  method  of  disposal  of  tlie  body  by  a  murderer  is  unusual, 
however,  and  a  careful  examination  of  the  knots  and  turns  in 
the  rope  will  indicate  that  they  have  been  made  by  the  person 
himself  before  taking  his  own  life. 

"  A  man,  with  his  wife  and  child,  was  reduced  to  great  distress. 
On  a  certain  day  he  took  an  affectionate  leave  of  his  family,  de- 
claring he  would  not  return  until  he  had  procured  some  em- 
ployment by  which  he  would  be  able  to  buy  bread  for  them. 
On  the  following  day  he  was  found  drowned  in  the  New  River, 
with  his  hands  and  legs  tied.  A  card  with  his  address  was 
found  in  his  pocket." 

Casper  also  relates  the  following  interesting  history,  when  the 
person  had  been  murdered  and  then  tied  up  and  the  theory  of 
suicide  was  disproved  by  the  head  injuries  : 

"In  April,  1848,  an  unknown  body  was  taken  out  of  the 
Spree,  which  was,  however,  soon  recognized  as  the  body  of 
a  shipmaster,  who  disappeared  from  his  vessel  on  the  evening 
of — say  the  i8th  of  March,  1848,  and  had  not  since  been  seen. 
A  well-grounded  suspicion  of  robbery  and  murder  was  directed 
against  the  servant  of  the  deceased,  who,  on  the  morning  of 
the  1 8th  of  March,  when  no  man  in  Berlin  could  foresee  the 
dreadful  termination  of  the  day,  had  locked  up  a  consider- 
able sum  of  money  for  his  master,  which  was  missing  from  the 
broken  chest  on  board  the  ship,  and  part  of  which,  along  with 
articles  of  clothing  belonging  to  the  deceased,  was  found  with 
the  servant,  who,  however,  obstinately  denied  his  guilt.  For 
the  accusation,  it  was  a  most  ])robable  supposition,  that  the 
servant,  on  the  evening  of  the  i8th  of  March,  when  the  fires  of 
riot  raged  in  Berlin,  had  taken  advantage  of  the  general  anar- 
chy and  confusion  to  perpetrate  a  robbery  and  murder,  which 
he  might  hope  would  remain  undiscovered  at  such  a  time.*  *  * 

"  But  to  return  to  the  dissection,  at  which  of  course  we  had  not 
the  slightest  suspicion  of  these  discoveries.  The  body  when  taken 
out  of  the  water  had  on  a  thick  brown  cloth  overcoat,  a  handker- 
chief and  several  xz.<i.?,\vQ.x(t  wound  round  the  head,  and  //V^/with  a 
cord  round  the  neck,  the  legs  were  also  tied  together  with  a 
string.  The  body  was  already  grayish-green,  consequently  far 
advanced  in  putrefaction.  (The  temperature  of  the  spring  had 
been  with  us  continuously  high).  The  bluish-green  and  swol- 
len tongue  protruded  from  between  the  toothless  jaws.  No 
mark  of  strangulation  could  be  seen  upon  the  neck. 


282  MEDICAL   JURISPRUDENCE. 

"But  there  were  important  cranial  injuries,  one  three  cornered 
one  with  blunt  ragged  edges  over  each  eyebrow,  and  one  an 
inch  long  on  the  right  parietal  bone  ;  in  at  least  two  of  these 
wounds  ecchymoses  were  brought  to  light  by  incisions.  When 
the  epicranial  aponeurosis,  covered  with  half  coagulated  blood, 
was  torn  off  we  found  a  complete  smashing  of  the  whole  skull, 
including  even  the  basis  cranii  !  The  brain,  a  (bloody)  pap, 
as  is  always  the  case  in  bodies  so  far  advanced  in  putrefaction, 
could  no  longer  be  investigated. 

"  The  lungs,  especially  the  right  one,  were  distended  with 
black  and  not  very  fluid  blood  ;  the  trachea  and  larynx  were 
blackish-blue  from  putrescence,  and  empty  ;  the  heart  was  per- 
fectly empty,  as  were  also  the  large  thoracic  vessels  ;  the 
stomach  empty,  as  was  also  the  urinary  bladder ;  of  course  in 
such  a  degree  of  putridity  the  vena  cava  was  likewise  empty, 
and  except  the  advanced  degree  of  putrescence  of  all  its  organs 
there  was  nothing  else  remarkable  in  the  abdomen.  It  was,  as 
is  evident,  a  very  plain  case.  It  was  just  as  difficult  to  under- 
stand why  a  suicide  should  have  so  bound  and  tied  his  head 
and  legs,  even  if  he  could  have  done  so  before  throwing  him- 
self into  the  water,  as  to  conceive  what  could  have  induced  a 
third  party  to  do  so,  when  his  intention  was  simply  to  throw 
the  man  into  the  water  and  drown  him.  There  were  certainly 
no  proofs  found  in  the  body  of  death  from  drowning,  and  the 
advanced  stage  of  putrescence  would  have  rendered  these  very 
uncertain  even  had  the  man  been  actually  drowned — but  it  was 
easy  to  prove  that  this  shipmaster  had  not  been  drowned,  but 
had  been  killed  by  the  fearful  cranial  injuries  inflicted  on  him, 
and  afterwards  bound  up  and  thrown  into  the  water,  since  the 
ecchymoses  found  proved  that  these  injuries  must  have  been 
inflicted  during  life,  and  thus  rendered  untenable  the  assump- 
tion that  they  might  possibly  have  been  accidentally  inflicted 
on  the  corpse  while  floating  in  the  water.  Moreover,  the  na- 
ture of  these  important  cranial  injuries,  particularly  the  fracture 
of  the  basis  cranii,  always  necessarily  presupposes  the  employ- 
ment of  the  utmost  violence  by  means  of  blunt  weapons — we 
adduced  as  examples  of  such  an  ax,  hammer,  club,  etc. — such 
as  could  not  possibly  happen  by  simply  floating  against  piles, 
or  by  being  struck  by  stones  or  rudders.  Accordingly — apart 
from  the  then  statutory  questions — we  assumed  that  the  de- 
ceased had  not  been  drowned,  but  had  been  killed  by  (absolute- 
ly fatal)  cranial  injuries,  and  only  thrown  into  the  water  after 
death,  and  that  these  cranial  injuries  had  been  inflicted  with 
very  considerable  violence,  and  with  a  blunt  weapon. 


SUICIDE.  283 

"  So  much  for  our  task;  the  reader  will  perhaps  be  interested 
in  the  following  appendix.  Every  body  was  fully  convinced  of 
the  guilt  of  the  accused,  and  yet  the  verdict  was  as  it  ought — 
'  not  guilty  ! '  For  the  identity  of  the  body  was  doubtful,  as 
first  appeared  at  the  time  of  the  public  oral  trial.  The  widow 
of  the  murdered  man,  living  in  a  small  provincial  town,  was 
summoned  to  the  trial  in  order  to  confirm  supplementarily  the 
identity  of  the  body  from  the  articles  of  clothing,  and  the  ex- 
ternal description  of  the  body  contained  in  our  protocol  of  the 
inspection — she  had  not  been  summoned  for  this  purpose  at 
the  discovery  of  the  body,  because  it  was  at  that  time  wholly 
unknown.  She  recognized  the  articles  of  clothing,  but  when 
questioned  about  the  color  and  condition  of  the  hair,  eyes, 
and  teeth,  etc.,  of  her  husband,  this  very  feeble  minded  woman 
gave  indistinct  and  wavering  answers.  Thus,  as  we  said,  it  ra- 
mained  doubtful  whether  the  body  of  the  murdered  man  was 
that  of  shipmaster  K.,  and  therewith  fell  the  proof  that  the  ac- 
cused, his  servant,  had  murdered  his  master." 

In  some  cases  we  shall  find  evidences  of  disease  which  has 
given  rise  to  delirium  leading  to  the  act  of  self-destruction,  and 
I  regard  such  help  as  very  important.  The  appearances  of 
inflammation  of  the  brain,  effusion  of  lymph,  and  signs  of  men- 
ingitis are  too  important  to  be  overlooked. 

Condition  of  tlie  Organs  of  Circnlation. — Writers  upon 
medical  jurisprudence  suggest  that  the  condition  of  the  organs 
of  circulation  will  often  enable  us  to  arrive  at  a  correct  idea  as 
to  the  condition  of  the  person  just  before  death,  and  the  ques- 
tion whether  there  has  been  a  struggle  ;  we  are  also  to  take 
into  account  the  degree  of  cerebral  congestion.  In  cases 
where  death  has  presumably  occurred  before  the  body  was 
thrown  into  the  water  we  of  course  find  none  of  the  physical 
evidences  of  death  by  drowning,  which  a  struggling  man  makes 
who  is  at  first  in  possession  of  his  senses. 

Suggestion  of  Putrefaction. — Caspar  refers'to  the  many 
difficulties  that  may  beset  us  in  our  attempt  to  unravel  the  mys- 
tery that  belongs  to  many  doubtful  suicides.  He  speaks  of  the 
post-mortem  changes  that  are  to  be  found  when  a  body  has  re- 
mained a  long  time  in  the  water,  is  consequently  putrified,  and 
where  there  has  been  an  escape  of  blood  into  the  cellular  tis- 
sue, and  he  tells  us  how  easy  it  is  to  mistake  such  conditions, 
as  well  as  those  post-mortem  elevations  of  the  scalp  which  de- 
pend upon  effusions  of  blood  as  the  result  of  putrefactive  de- 
composition, for    injuries  supposed  to    have   been  inflicted  by 


284  MEDICAL   JURISPRUDENCE. 

Other  persons.  It  is  never  safe  to  testify  too  positively  in  re- 
gard to  the  state  of  the  body  of  those  not  recently  drowned, 
and  it  is  just  such  cases  in  regard  to  which  ignorant  people 
are  inclined  to  form  hasty  opinions. 

Weights  in  the  Pockets  of  Deceased. — it  is  held  by 

some  authors  that  the  presence  of  stones  in  the  pocket  of  the 
suicide,  where  there  are  no  marks  of  violence  upon  the  body, 
is  suggestive  of  suicide,  although  it  is  not  uncommon  for  a 
murderer  to  attach  weights  to  the  body  of  his  victim  ;  but  in 
the  latter  case  we  shall  probably  find  that  there  are  some  evi- 
dences of  a  struggle. 

Suicide  and  Drunkenness. — We  are  also  to  be  on  our 

guard  in  regard  to  the  fact  whether  the  drowning  lias  been  the 
result  of  a  drunken  spree.  The  presence  of  written  matter  upon 
the  person  of  the  suicide,  or  notes  in  his  diary,  of  course  need 
hardly  be  mentioned  as  suggestive  hints  which  should  enable 
us  to  form  an  opinion. 

Suicide  hj  Hanging. — French  medical  literature  abounds 
with  cases  in  which  the  question  of  suicidal  hanging  arises,  and  in 
this  connection  some  examples  are  reported  of  murderers  who 
have  first  disposed  of  their  victim,  and  then  suspended  him  to 
give  the  idea  that  he  had  taken  his  own  life.  Such  examples  are 
rare  in  this  country,  and  it  is  onl)^  in  those  cases  where  the 
victim  has  first  been  poisoned,  that  the  diagnosis  of  the  mode 
of  death  might  be  obscured.  Even  in  some  instances  the  pos- 
sible detection  of  its  presence  might  be  easy,  but  a  mur- 
derer would  not  resort  to  so  clumsy  a  method,  for  he  would  not 
be  sure  of  the  duration  of  the  effects  of  the  ])oison  before  death 
actually  occurred.  In  most  of  the  reported  cases  there  are  head 
injuries  that  could  not  be  self-inflicted.  It  is  undoubtedly  the 
fact  that  sometimes  the  suicide  resorts  to  several  methods  before 
he  ends  wi,th  hanging  to  make  sure.  Taylor  says  : — "  The  dis- 
covery of  a  person  dead  from  hanging  is  presumption  of  suicide 
all  other  circumstances  being  equal."  He,  however,  makes 
certain  exceptions,  which  are  : — "  i.-  The  fact  of  the  person 
hanging  being  feeble,  and  the  assailant  a  strong  man  ;  2  The 
fact  that  the  ])erson  hanging  has  been  stupified  by  narcotics,  or 
intoxicated,  or  has  been  worn  out  and  exhausted  in  a  struggle  ; 
3.  In  all  cases  when  a  number  ol  men  are  arrayed  against  one 
(Lynching.)" 

In  homicidal  hanging  there  are  usually  some  marks  resulting 
from  a  struggle  with-the  assailant,  although  this  is  by  no  means 


SUICIDE 


285 


Decessarily  so.  Taylor  lefers  to  the  case  of  a  woman  who  hung 
her  husband  who  while  lying  asleep  was  approached  by  his 
wife  who  managed  to  twist  a  rope  about  his  neck  and  tie  it  to 
0  beam  raising  his  head.  The  husband  who  went  to  bed  sober 
denied  all  knowledge  of  the  murderous  attempt  when  he  was 
resuscitated.  The  wife  was  drunk  and  Taylor  thinks  the  man 
must  have  been  likewise,  and  this  author  does  not  believe  that 
any  attempt  of  this  kind  could  have  been  carried  out  unless 
such  was  the  case. 


Suicidal  Hanging. 
(Taylor.) 

No  reliance  can  be  placed  upon  the  statement  of  some  au- 
thors who  believe  that  a  differential  sign  between  suicidal  and 
homicidal  hanging  is  that  in  the  latter  two  marks  of  the  rope 
will  be  found  upoti  the  neck  of  the  dead  body. 

Careful  autopsical  investigations  may  reveal  in  suspected 
cases  the  marks  of  homicidal  violence,  rupture  of  the  internal 
organs  for  example. 

The  Case  of  the  Due  de  Bourbon.— Winslow,  in  his 
"Anatomy  of  Suicide,"  relates  the  following  cases,  the  first  of 
which  is  the  celebrated  case  of  the  Due  de  Bourbon  : 

"On  the  27th  August,  1830,  the  duke  was  found  suspended 
in  his  bedroom,  in   the  Chateau  of  St.  Leu.     An  inquest  was 


286  MEDICAL    JURISPRTJDENCE, 

held  the  same  morning  on  the  body,  and  from  the  evidence  of 
the  witnesses,  as  well  as  from  the  reports  of  the  physicians  and 
surgeons  who  examined  it,  a  verdict  was  returned  to  the  effect 
th:it  the  duke  had  committed  suicide  in  a  fit  of  temporary  in- 
sanity. This  event  did  not  excite  much  notice  until  the  con- 
tents of  his  will  were  made  public.  The  deceased,  it  appears, 
had  made  his  will  in  favor  of  the  Baroness  de  Feucheres,  a  female 
who  had  lived  with  him  for  some  years,  bequeathing  to  her  the 
whole  of  his  immense  estates,  and  leaving  the  Duke  d'Aumale, 
the  youngest  son  of  the  king  of  the  French,  residuary  legatee. 
The  Princes  de  Rohan,  heirs  by  collateral  descent  to  the 
deceased,  thus  finding  themselves  deprived  of  an  expected 
inheritance,  attempted  to  set  aside  the  will,  alleging  that  undue 
influence  had  been  exercised  over  him.  The  cause  came  on 
for  hearing  before  the  First  Chamber  of  the  Civil  Tribunal  of 
Paris,  in  December  1831,  and  excited  considerable  attention, 
not  so  much  in  consequence  of  the  dispute  concerning  the 
validity  of  the  will,  as  of  the  question  which  was  raised  during 
the  trial — whether  the  duke  had  committed  suicide,  or  whether 
he  had  been  murdered,  and  afterward  suspended  in  order  to 
defeat  the  ends  of  justice.  The  facts  of  the  case,  collected 
from  the  proces  verbaux,  are  as  follows  : 

"  The  deceased  had  naturally  partaken  of  the  alarm  which 
had  diffused  itself  throughout  France  in  consequence  of  the 
events  of  the  revolution  of  1S30.  Some  of  his  most  intimate 
friends  declared  that  for  some  time  previously  to  his  death,  his 
mind  had  been  filled  with  the  most  gloomy  forebodings  as  to 
what  this  new  order  of  things  would  bring  about.  On  the 
morning  of  the  27th  his  servant  went  as  usual  to  his  bedroom 
door  about  eight  o'clock  ;  but  receiving  no  answer  on  knocking, 
he  became  alarmed.  Madame  de  Feucheres  then  accompanitd 
the  valet  to  the  door  of  the  room  which  was  fastened  on  the 
inside  ;  and  receiving  no  reply  after  calling  to  the  duke  in  a 
loud  voice,  she  ordered  it  to  be  broken  open.  On  entering  the 
apartment,  the  body  of  the  deceased  was  found  suspended 
from  the  fastening  at  the  top  of  the  window  sash  by  means  of  a 
linen  handkerchief,  attached  to  another  which  completely 
encircled  the  neck.  The  head  was  inclined  a  little  to  the 
chest  ;  the  tongue  protruded  from  the  mouth  ;  the  face  was 
discolored  ;  a  mucous  discharge  issued  from  the  mouth  and 
nostrils  ;  the  arms  hung  down,  the  fists  were  clenched.  The 
extremities  of  both  feet  touched  the  carjiet  of  the  room,  the 
point  of  suspension  being  about  six  feet  and  a  half  from  the 
floor  ;  the  heels  were  elevated,  and  the  knees  half  bent.     The 


SUICIDE,  287 

deceased  was  partly  undressed  :  the  legs  were  uncovered  and 
had  some  marks  of  injury  on  them.  Among  other  points  of 
circumstantial  evidence,  it  was  remarked  that  a  chair  stood 
near  the  window  to  which  the  deceased  was  suspended,  and 
the  bed  looked  as  if  it  had  been  lain  on. 

"The  medical  witnesses,  who  examined  the  body  soon  after 
its  discovery,  stated  that  they  found  it  cold,  and.  the  extremi- 
ties rigid,  from  which  they  inferred  that  the  deceased  had  been 
dead  eight  or  ten  hours.  This  would  have  fixed  the  time  of 
his  death  at  midnight  of  August  26th.  The  body  underwent 
a  second  examination,  a  report  of  which  was  furnished  to  the 
legal  authorities  on  the  following  day.  Five  medical  men  were 
present  at  the  inspection  ;  and  they  gave  it  as  their  opinion 
from  the  post  mortem  appearances  :  i.  That  the  deceased  had 
di-ed  by  hanging  ;  and,  2.  From  the  absence  of  all  marks  of 
violence  or  assistance  about  the  person  or  clothes  of  the 
deceased,  and  other  facts,  that  he  had  destroyed  himself.  They 
considered  that  the  contusion  on  one  arm  and  the  excoriations 
observed  on  both  legs,  must  have  arisen  from  the  rubbing  of 
these  parts  against  the  projecting  rail  of  the  chair  near  the 
window.  The  mark  on  the  neck  of  the  deceased  they  described 
to  be  large,  oblique  and  extending  upwards  to  the  mastoid 
process. 

"  General  evidence  was  given  to  show  that  the  Duke  had  medi- 
tated self-destruction,  and  had  conversed  about  it  with  some  of 
the  witnesses.  On  the  morning  of  the  28th,  some  fragments  of 
paper  which  had  been  written  on  were  taken  from  the  grate  of 
his  chamber  ;  these  were  carefully  put  together  by  one  of  the 
legal  inspectors  ;  and  among  a  few  disjointed  sentences,  indi- 
cating despair  and  a  dread  of  impending  danger,  were  the  fol- 
lowing : —  *  It  is  only  left  for  me  to  die  in  wishing  prosperity  to 
the  French  people  and  my  country.  Adieu  forever  !  '  Here 
followed  his  signature  and  a  request  to  be  interred  at  Vin- 
cennes,  near  the  body  of  his  son,  the  Duke  d'Enghien.  It  is 
necessary  to  observe  that  no  noise  or  disturbance  was  heard  in 
the  bedroom  on  the  night  of  the  deceased's  death. 

"On  the  other  hand  it  was  contended  that  the  duke  was  not 
unusually  melancholy  before  his  death  ;  that  the  supposition  of 
suicide  was  inadmissible  in  a  moral  point  of  view,  and  indeed, 
was  physically  impossible,  from  the  circumstances.  One  per- 
son argued  that  he  could  not  have  made  the  knots  seen  in  the 
handkerchief  ;  another  that  he  could  not  have  reached  so  high 
above  his  head  to  have  suspended  himself,  and  that  the  chair 
could  not  have  been  used  in  any  manner  to  assist  him  ;  while  a 


a88  MEDICAL  JURISPRUDENCE. 

third  affirmed  that  a  person  might  be  suspended  in  the  position 
in  which  the  body  was  discovered,  without  death  ensuing.  The 
circumstance  of  the  door  being  fastened  on  the  inside  was 
accounted  for  by  supposing  that  the  bolt  had  been  pushed  to 
from  the  outside.  The  duke  had  been  heard  to  condemn  sui- 
cide ;  he  had  made  an  appointment  for  the  following  day  ;  and 
had  attended  to  many  little  circumstances,  such  as  winding  up 
his  watch  the  night  previously  and  noting  his  losses  at  play  ; 
facts  which  were  forcibly  urged  as  being  opposed  to  the  sup- 
position of  his  having  destroyed  himself. 

"  To  combat  the  medical  evidence,  it  was  assumed  that  the 
deceased  was  strangled  or  suffocated,  and  was  afterwards 
hanged  by  assasins.  Several  schemes  were  devised  by  the  med- 
ical witnesses  on  this  side  of  the  question,  to  account  for  the 
manner  in  which  the  supposed  murder  was  committed. 

"According  to  some,  a  handkerchief  might  have  been  tight- 
ened round  the  deceased's  neck  by  one  assassin,  while  another 
forcibly  held  his  legs  under  the  bedclothes,  by  which  the  lesions 
already  described  would  have  been  produced,  or  instead  of  be- 
ing strangled  by  a  handerchief,  he  miglit  have  been  suffocated 
by  a  pillow  placed  over  his  mouth.  The  body  might  then  have 
been  dragged  across  the  room  to  be  suspended  ;  and  if  during 
this  time  the  hand  of  one  of  the  assassins  had  been  rudely 
thrust  between  the  cravat  and  the  neck,  the  excoriation  and 
mark  seen  on  the  skin  might  be  accounted  for.  The  counsel 
for  the  appellants  remarked  that  the  want  of  a  line  in  writing, 
to  withdraw  from  all  suspicion,  his  attendants  and  even  Madame 
de  Feucheres,  was  remarkable,  as  this  latter  precaution  had  sug- 
gested itself  to  almost  every  suicide.  He  condemned  those  en- 
gaged in  the  anatomical  examination  of  the  body,  as  having 
been  guilty  of  culpable  mismanagement.  He  ridiculed  the 
idea  that  the  duke,  as  reported  by  the  two  physicians  consulted, 
had  probably  come  to  his  death  through  asphyxia  by  strangu- 
lation. He  contended  that  all  tlie  appearances  on  the  skin  of 
the  neck,  where  no  ecchymosis,  as  is  usual  in  persons  hung 
alive,  was  visible,  showed  that  death  had  preceded  the  hanging  of 
the  body. 

Beck  reports  a  case  of  a  suicide,  and  the  punishment  of  an 
innocent  person  for  supposed  murder  :  "  Marc  Antoine  Galas 
was  the  son  of  John  Galas,  a  merchant  of  Toulouse, 
aged  seventy  years,  of  great  probity  and  a  Protestant. 
He  was  twenty-eight  years  of  age,  of  a  robust  habit, 
but  of  a  melancholy  turn  of  mind.       He  was  a  student   of  law, 


StJICIDE,  289 

?nd  becoming  irritated  at  the  difficulties  he  experienced  (in 
consequence  of  not  beins;  a  Catholic)  concerning  his  license, 
he  resolved  to  hang  himself.  This  he  executed  by  fastening 
the  cord  to  a  billet  of  wood  placed  on  the  folding  doors  which 
led  from  his  father's  shop  to  his  store  room.  Two  hours  after- 
wards he  was  found  lifeless.  The  parents  unfortunately  re- 
moved the  cord  from  the  body  and  never  exhibited  it  to  show 
in  what  manner  his  death  was  accomplished.  No  examination 
was  m^ade.  The  people,  stimulated  by  religious  prejudice,  car- 
ried the  body  to  the  town-house,  where  it  was  the  next  day  ex- 
amined by  two  medical  men  who,  without  viewing  the  cord  or 
the  place  where  the  death  had  been  consummated,  declared 
that  he  had  been  strangled.  On  the  strength  of  this,  the  father 
was  condemned  by  the  parliament  of  Toulouse,  in  1761:,  to  be 
broken,  on  the  wheel.  He  expired  with  protestations  to  heaven 
of  hi?  innocence, 

''  Reflection,  however,  returned  when  it  was  too  late.  It  was 
recollected  that  the  son  had  been  of  a  melancholy  turn  of  mind  ; 
that  no  noise  was  heard  in  the  house  while  the  deed  was  doing  ; 
that  his  clothes  were  not  in  the  least  ruffled  ;  that  a  single  mark 
only  was  found  from  the  cord,  and  which  indicated  suspension 
by  suicide  ;  and  in  addition  to  these,  that  the  proper  dress  for 
the  dead  was  found  lying  on  the  counter. 

"  Voltaire  espoused  the  cause  of  the  injured  family  and  attract- 
ed the  eyes  of  all  Europe  to  this  judicial  murder.  The  cause  was 
carried  up  to  the  Council  of  State,  who  on  the  19th  of  May, 
1765,  reversed  the  decree  of  parliament  and  vindicated  the 
memory  of  John  Calas." 

Suicide  hj  Poisoning. — Suicide  by  poison,  as  I  have 
said,  is  more  commonly  resorted  to  by  women  than  by  men  ; 
and  oftentimes  there  is  no  difficulty  in  determining  whether 
the  method  of  death  was  suicidal  or  homicidal.  As  a 
rule,  the  poisons  used  by  suicides  are  those  which  would  not 
be  selected  by  a  designing  murderer,  and  especially  true  is  this 
among  the  lower  classes.  In  the  city  of  New  York,  Paris  green, 
which  is  bulky  and  undisguisable,  is  employed  very  much  more 
often  than  any  other  substance  for  the  purpose  of  self  destruc- 
tion, and  laudanum  perhaps  comes  next.  The  mineral  acids 
and  oxalic  acid,  as  well  as  other  irritant  substances,  are  fre- 
quently made  use  of  for  the  purpose.  As  most  of  these  poisons 
do  not  kill  immediately,  we  are  often  enabled  to  watch  the 
patient,  and  consequently  learn  the  nature  of  the  crime  ;  for  as 
a  rule  a  period  of  regret  and  remorse  attends  the  commence- 


290  MEDICAL   JURISPRUDENCE. 

ment  of  disagreeable  effects,  and  in  the  majority  of  cases  the 
would-be  suicide  appeals  piteously  for  help. 

The  doubtful  cases  are  those  where  narcotics  are  admin- 
istered and  where  unconsciousness  rapidly  supervenes.  The 
selection  of  the  poison  should  be  taken  into  account  and  may 
have  a  modifying  influence  upon  the  opinion  of  the  expert. 

It  is  not  rare  to  find  a  certain  epidemic  character  in  the  oc- 
currence of  self-destruction,  and  I  have  known  of  several  per- 
sons who  used  some  unusual  poison,  the  fashion  having  been 
set  by  a  suicide  the  circumstances  of  whose  crime  were  widely 
spread  in  the  newspapers.  Thus  the  daily  press  may  teem 
with  cases  of  poisoning  by  cyanide  of  potassium  or  chloroform, 
or  perhaps  some  well  known  rat-poison,  all  occurring  within  a 
short  time. 

Sometimes,  as  I  have  said,  a  person  will  disavow  his  inten- 
tion of  committing  suicide.  Such  a  case  is  reported  by  Caspar, 
the  subject  being  a  strong,  healthy  apprentice,  sixteen  years 
old,  who  had  declared  during  an  illness  that  some  one  had  given 
him  sulphuric  acid  to  drink  instead  of  a  dram.  'I  he  circum- 
stances that  there  were  no  marks  of  cauterization  on  the  lips, 
and  that  the  appearances  on  dissection  betokened  that  no  in- 
considerable quantity  had  been  swallowed,  prove  indubitably 
that  this  statement  was  untrue,  and  that  his  illness  and  death 
had  been  voluntarily  induced.  The  tongue  was  white,  and  the 
epithelium  were  easily  scraped  off.  Besides,  very  active  appear- 
ances of  deep  tissue  changes  and  perforations  of  the  pharynx 
and  stomach,  and  a  collection  of  grumous  blood  were  observed, 
and  there  were  other  evidences. 

Evidences  of  Pre-Existing  Disease. — We  are  to  ex- 
amine into  the  possibility  of  some  serious  form  of  bodily  injury 
or  disease.  While  suicide  is  extremely  rare  among  consumptives, 
we  often  find  it  resorted  to  by  the  victims  of  alcoholism  in  its 
various  forms,  neuralgia  and  other  conditions  of  the  nervous 
system  attended  by  great  pain  and  suffering.  A  perfectly  well 
and  happy  man  is  very  unlikely  to  commit  suicide,  and  where 
an  allegation  of  self-destruction  is  made,  especially  by  interest- 
ed persons,  it  is  but  natural  that  we  should  be  suspicious. 

Hallucinations  and  Suicide. — Hallucinations  very  often 
lead  to  the  commission  of  suicide.  Much  has  been  said  about 
their  influence,  as  well  as  that  of  otlicr  forms  of  insanity  upon  a 
previous  page,  but  I  may  be  pardoned  for  referring  to  an  inter- 
esting case  at  this  i)lace  in  illustration  of  a  very  common 
incentive.     It  is  related  by  Brierre  de  Boismont : 


SUICIDE.  2^1 

*  A  man  employed  in  a  tobacco  manufactory  began  by  re- 
proaching himself  for  embezzlement.  He  struggles  against 
this  idea,  but  it  will  not  quit  him  ;  he  thinks  then  that  he  sees 
at  every  instant  the  police  around  him,  who  come  to  hurry  him 
away  to  the  scaffold.  Wishing  to  spare  his  wife  this  shame,  he 
remained  an  entire  night,  while  she  was  asleep,  with  the  razor 
at  his  throat.  Fortunately  the  thought  changed  ;  perhaps  he 
yielded  to  a  gleam  of  reason,  to  an  instinctive  movement  of  af- 
fection ;  he  threw  away  the  deadly  instrument.  The  next  day 
he  was  brought  to  the  establishment  in  which  I  was  physician. 
For  two  days  he  had  been  unceasingly  pursued  by  the  same 
vision.  I  had  just  quieted  him,  when  in  about  a  qua^fer  of  an 
hour  he  was  found  drowned  in  a  small  garden  tub,  from  which 
he  was  extricated  with  difficulty.  If  this  man  had  cut  his 
wife's  throat  and  killed  himself  afterwards,  the  cause  of  this 
fearful  tragedy  would  have  been  attributed  to  any  but  the  right 
motives." 

The  Love  of  Notoriety. — It  is  well  known  that  an  all- 
absorbing  love  of  notoriety  may  lead  the  person  to  take  his  own 
life.  Forbes  Winslow  collects  a  number  of  cases  which  are  not 
without  interest. 

"  The  man  who  was  killed  by  attaching  himself  to  a  rocket, 
and  he  who  threw  himself  into  the  crater  of  Mt.  Vesuvius,  were 
no  doubt  stimulated  by  a  desire  for  posthumous  fame. 

^'  Some  years  ago,  a  man  hung  himself  on  the  threshold  of 
one  of  the  doors  of  the  corridor  at  the  Hotel  dcs  Invalides.  No 
suicide  had  occurred  in  the  establishment  for  two  years  pre- 
viously ;  but  in  the  succeeding  fortnight  y?^^  invalids  hung  them 
selves  on  the  sa?fie  cross  ba?;  and  the  governor  was  obliged  to 
shut  up  its  passage." 

Relation  of  Life  Insurance  to  Suicide. — The  relation 
of  suicide  to  life  insurance  is  one  occasionally  giving  rise  to 
law-suits^  for  it.  is  no  unusual  thing  for  a  person  to  heavily 
insure  his  life,  and  then  under  the  pressure  of  impending  ruin 
make  way  with  himself,  so  that  his  family  may  be  provided  for. 
It  is  true  that  but  few  of  such  cases  have  been  contested  in  the 
courts,  and  the  point  at  issue  has  been  the  question  of  the  in- 
sanity of  the  suicide.  While  it  is  difficult  to  imagine  that  any 
earthly  ends  of  a  sordid  nature  are  greater  than  the  love  of 
life,  still  we  must  confess  that  the  same  motive  that  leads  a 
soldier  into  battle,  or  to  enter  a  forlorn  hope  where  death  is 
certain,  may  in  another  and  a  dishonorable  way  be  productive 


292  MEDICAL   JURISPRUDENCE. 

of  an  act  of  felo  de  se  j  and  in  the  majority  of  cases  reported 
there  is  no  reason  to  suppose  that  the  insured  is  not  in  his  right 
mind. 

One  of  the  earHest  cases  of  suicide  attempted  for  the  purpose 
of  defrauding  a  hfe  insurance  company  was  that  of  "  Borrodailc 
vs.  Hunter,"  which  was  tried  in  England  in  December,  1841. 
The  Rev.  WiUiam  Borrodaile  had  insured  his  hfe  for  the  sum 
of  one  thousand  pounds  in  the  London  Life  Association,  on 
February  16,  1841.  He  made  dehberate  preparations,  and 
cHmbed  over  the  parapet  of  Vauxhall  Bridge,  threw  himself 
into  the  river  and  was  drowned.  The  suit  was  brought  to  re- 
cover the  sum  of  the  policy,  and  was  contested  by  the  insurance 
company.  The  Rev.  Mr.  Borrodaile  had  always  been  a  man 
of  happy  and  even  temperament,  conscientious,  and  respected 
by  every  one.  A  year  or  so  before  his  death  he  became  res- 
ponsible for  a  tax  collector,  who  shortly  afterwards  turned  de- 
faulter, and  this  action  so  shocked  the  reverend  gentleman  that 
hesettled  into  a  condition  of  melancholy,  was  greatly  depressed, 
evinced  loss  of  memory,  was  reserved,  taciturn,  and  suffered 
greatly  through  physical  changes,  loss  of  sleep,  and  was  to  all 
practical  purposes  not  in  his  right  mind.  He  told  the  wife  of 
the  tax  collector  that  he  did 'not  know  sometimes  what  he  was 
doing  or  where  he  was  going,  and  appeared  to  have  lost  all 
control  over  himself.  So  great  was  his  want  of  confidence 
that  he  begged  his  brother-in-law  not  to  leave  him.  His  altered 
demeanor  was-conspicuous,  he  no  longer  paid  attention  to  his 
religious  duties,  and  went  through  those  required  of  him  in  a 
mechanical  way,  and  was  seemingly  in  a  daze.  On  the  day  of 
the  suicide  he  appeared  to  better  advantage,  and  left  the  house 
dressed  for  traveling,  ostensibly  to  see  his  wife.  He  was  at  a 
neighboring  village,  but  expressed  his  intention  of  returning  in 
time  for  dinner  at  six  o'clock.  He,  however,  never  returned 
to  his  home.  The  policy  was  contested  by  the  company,  and 
it  was  alleged  that  a  provision  of  the  same  had  been  violated, 
the  insured  having  died  by  his  own  hand  ;  that  in  addition, 
there  was  nothing  in  his  behavior  to  prove  him  to  be  of  unsound 
mind.  The  charge  of  Justice  Erskine  in  this  case  is  one  that 
has  been  often  referred  to  since.  He  says  :  "  In  this  case  there 
could  be  no  dispute  as  to  the  facts,  but  the  question  resolved 
itself  into  adry  point  of  law,  on  the  finding  of  the  jury  whether 
a  party  who  dies  by  his  own  hand,  unconscious  of  right  and 
wrong,  thereby  avoids  the  ])olicy."  "  There  could  be  no  doubt 
that  the  insured's  throwing  liimself  into  tlie  water  M'as  his  own 
voluntary  act,  but  whether   he  had  the   will  to  destroy  himself 


SUICIDE.  293 

knowing  what  the  consequences  of  throwing  himself  into  the 
water  would  be,  was  a  question  which  he  must  leave  to  them 
(the  jury)  to  decide  upon  the  evidence."  Tlie  verdict  was  en- 
tered for  the  defendants,  with  leave  to  move  to  enter  it  for 
plaintiff.  This  verdict  was  arrived  at  by  the  jury,  who  decided 
that  Borrodaile  had  shown  no  previous  evidences  of  insanity 
before  the  suicidal  act  which  he  had  eventually  committed  for 
the  purpose  of  destroying  himself,  and  "  that  he  was  not  capable 
of  judging  between  right  and  wrong  at  the  time  that  Mr.  B. 
threw  himself  from  the  bridge  with  the  intention  of  destroying 
himself."  A  year  later  an  appeal  was  taken  from  this  finding, 
Sir  Thomas  Wilde  moving  that  a  verdict  be  entered  for  plain- 
tiff, and  contending  that  "  after  all,  the  jury  had  found  that 
Mr.  Borrodaile  was  non  compos  mentis  :  "  and  argued  that  the 
condition  of  the  policy,  by  which  it  was  provided  that  the 
policy  should  be  void  in  the  event  of  the  party,  dying  by  his 
own  hand,  must  be  construed  to  mean  ''in  the  event  of  the 
party's  becoming /V/^"  de  se."  The  court  granted  a  rule  to  show 
cause.  Mr.  Sergeant  Channell  a  few  months  later  answered, 
that  the  deceased  had  thrown  himself  from  the  bridge  with  the 
intention  of  destroying  life,  and  knew  that  his  act  would  have 
this  result.  He  therefore  "  contended  that  if  the  insured  by 
his  own  agency  produced  death,  the  policy  Avas  void,  and  the 
verdict  ought  to  remain  with  defendants.  On  the  other  hand, 
it  was  urged  that  the  legal  result  of  the  verdict  excluded  inten- 
tion in  any  sense  which  could  make  the  policy  void,  and  that 
it  was  equivalent  to  a  verdict  of  non  compos  mentis.  It  was 
finally  decided  that  a  verdict  should  be  entered  for  plaintiff. 
In  this  case,  I  am  convinced  that  there  was  little  doubt  of  the 
insured's  insanity  ;  but  as  a  rule  such  cases  will  not  bear  the 
test  of  criticism. 

An  American  case  of  some  interest  is  that  of  "The  St.  Louis 
Life  Insurance  Company  vs.  Graves,"*  the  facts  in  brief  being 
the  following  :  Leslie  C.  Graves  married  Mary  E.  Searles,  both 
being  residents  of  Lexington,  Kentucky  ;  and  shortly  after  this 
marriage  he  insured  his  Ufe  for  her  benefit  in  the  above  com- 
pany for  the  sum  of  $5,000.  Four  months  after  the  date  of  the 
policy  the  insured  was  found  dead  and  alone  in  his  livery 
stable,  and  by  his  side  was  a  pistol  he  had  borrowed  from  a 
friend.  The  widow  brought  an  action,  averring  that  the  fatal 
shot  was  the  result  of  a  momentary  paroxysm  of  moral  insanity, 

*  N.  Y,  Daily  Transcript,  March  7,  1871,  and  Medico-Legal  Soc,  Re- 
ports, 1st  Series. 


294  MEDICAL    JURISPRUDENCE. 

and  he  had  been  deprived  of  self-control.  It  was  proved  by 
the  defense  that  Graves  had  for  a  day  nerved  himself  up 
with  liquor,  and  when  he  borrowed  the  pistol  and  when  he  did 
the  deed  he  was  wrought  up  to  a  pitch  of  reckless  courage. 
The  judge  to  whom  the  case  was  appealed  reversed  the  finding 
of  the  jury  in  the  woman's  behalf,  holding  tliat  the  act  was  vio- 
lent and  premeditated  notwithstanding  there  was  evidence  to 
show  his  amicable  relations  with  his  family,  and  the  absence  of 
what  might  appear  as  sufficient  motive. 

A  case  is  related  of  a  young  man  who  applied  to  a  dispensary 
physician,  and  asked  this  officer  to  insert  his  (the  young  man's) 
name  in  the  death  certificate  of  the  next  person  who  died  in 
the  hospital,  so  that  it  might  be  used  in  obtaining  the  payment 
of  a  policy. 

He  was  reduced  in  his  affairs  and  wanted  money  to  start  in 
business,  and  had  no  means  to  support  his  family.  He  had  a 
a  policy  on  his  life,  which  his  Avife  would  get  on  proof  of  his 
death.  He  committed  suicide  a  few  weeks  after  this  request. 
There  is  no  reason  to  suppose  this  individual  was  insane. 

Browne  refers  to  the  law  as  follows  :  "An  insurance  company 
is  not  liable  on  a  policy,  if  the  person  insured  voluntarily 
deprives  himself  of  life,  and  it  seems  to  have  been  held  over 
and  over  again  in  this  connection  that  voluntary  suicide  can 
be  committed  by  a  person  who  is  insane,  and  that  the 
mere  act  of  suicide  itself  gives  no  indication  of  the  mental 
condition  of  the  person  who  kills  himself.  The  real  ques- 
tion to  be  decided  in  all  these  cases  is  whether  the  insanity 
was  of  such  a  nature  as  to  deprive  the  individual  of  all  voli- 
tion, or  that  the  act  of  self-destruction  was  not  the  result  of 
the  will  and  intention  of  the  party  adapting  the  means  to  the 
act,  and  contemplating  the  physical  nature  and  effort  of  the 
act."  * 

A  case  of  suicide,  in  which  tlie  question  of  life  insurance 
arose,  is  reported  by  du  Saulle,  and  is  of  some  interest.  "  On 
the  seventh  day  of  September,  1858,  at  seven  o'clock  in  the 
morning,  a  pistol  shot  startled  the  stragglers  upon  one  of  the 
boulevards  of  Paris.  From  the  window  of  a  carriage  smoke 
was  seen  to  issue,  and  when  the  coachman  stopped  and  opened 
the  door,  he  found  in  a  corner  of  the  carriage  the  dead  body  of 
a  man  in  a  sitting  posture.  The  left  half  of  the  skull  was 
removed  by  an  explosion  of  a  double-barreled  shot-gun  placed 
between  the  victim's  legs.     This  man  who  died   almost  instan- 

*  Cooper  vs.  Massachusetts  Mul,  Life  Ins.  Co.  102  Mas.  327. 


SUICIDE.  295 

taneously,  had  insured  his  life  some  time  before  for  the  con- 
siderable sum  of  150,000  fr.,  and  the  companies  refused  to  pay, 
because  the  death  of  the  deceased  had  been  vokintary  and  not 
accidental.  In  alluding  to  this  case,  '  there  will  be  no  object,' 
says  Tardieu,  '  to  reproduce  here  the  motives  deducted  from 
our  observations  and  experiences  that  we  have  repeated  in  the 
same  carriage  wherein  the  body  was  found,  which  we  con- 
sider to  raise  the  supposition  of  an  accident,  or  to  conclude  a 
suicide.  We  have  satisfied  ourselves  in  regard  to  the  direction 
of  the  wound  on  the  head,  and  the  obliquity  which  existed  in 
the  position  of  the  weapon  in  relation  to  the  sides  of  the  car- 
riage. We  shall  demonstrate  in  the  most  positive  manner  that 
the  attempt  was  premeditated,  and  voluntary,  and  that  death 
was  not  the  result  of  an  accident,  but  a  suicide.'  On  his  side 
Brierre  de  Boismont  'sought  to  establish  that  many  of  the 
individuals  who  committed  suicide  preserved  in  the  midst  of 
their  preparations  a  coolness  and  indifference  which  was  re- 
markable, and  which  he  was  unable  to  find  in  the  bearing,  in 
the  letters,  and  in  the  last  acts  of  the  individual  in  question  ; 
which  was  moral  proof  that  he  was  not  himself  in  his  last 
hours.'  The  insurance  companies  were  condemned  to  pay  the 
amount  of  insurance." 

Homicide    or  Suicide  in  Life  Insurance    Cases  — 

The  question  of  fraud  sometimes  arises  when  the  insured  seeks 
to  create  the  impression  that  he  is  the  victim  of  an  assault. 

On  the  twelfth  day  of  October,  1840,  a  broker  was  found 
strangled  in  a  carriage,  on  the  road  to  Stettin.  The  bad  con- 
dition of  his  affairs,  it  was  thought,  had  led  him  to  commit 
suicide.  The  position  of  the  body,  wliich  had  the  hands 
crossed  behind  the  back,  the  traces  of  robbery,  led  the 
tribunal  to  recognize  the  evidences  of  a  violent  death,  and  a 
judicial  investigation  was  ordered  ;  however  without  any  result. 
The  broker  had  an  insurance  upon  his  life  for  the  sum  of  40, 
000  fr.,  which  would  have  been  sent  to  his  family  only  in  case 
that  death  had  not  been  the  result  of  suicide.  The  officers  of 
the  bank  of  Gotha  presented  themselves  before  the  justice, 
and  proved  that  the^  broker  had  really  committed  suicide. 
They  exhibited  an  autograph  letter  of  the  deceased,  in  which 
the  motives  that  impelled  him  to  commit  the  crime  were  shown, 
and  the  means  to  which  he  had  resorted.  The  result  of  this 
document  was  that  the  broker  had  sacrificed  his  life,  so 
that  the  family  might  be  provided  ^or  and  saved  from  com- 
])lete  ruin.     It  aopeared  from  this  letter  that  a  friend  was  after 


296  MEDICAL   JURISPRUDENCE. 

death  to  place  him  in  tlie  attitude  he  was  found,  for  the  pur- 
pose of  supporting  the  idea  that  he  had  been  assassinated,  (du 
Saulle). 

Tardieu  reports  an  extraordinary  example  of  homicidal  spec- 
ulation, which  occurred  in  Sweden  several  years  ago,  in  which 
a  French  company  came  very  nearly  being  swindled.  A  life 
insurance  was  taken  on  the  26th  of  March,  1856,  on  the  life  of 
H.,  a  servant,  for  the  benefit  of  S.,  a  commission  merchant. 
H.  was  an  unfortunate  drunkard,  who  hung  himself,  but  was 
rescued  and  saved  by  S.  This  fact  gave  the  idea  of  specula- 
tion, and  a  veritable  tacit  contract  was  made  with  H.,  who 
promised  to  drink  large  quantities  of  brandy  in  the  morning 
and  evening,  and  to  go  without  nourishment.  The  life  of  H.  was 
prolonged  through  the  agency  of  S.,  who,  fearing  the  payment 
of  a  new  premium,  had  had  violent  scenes  with  the  former. 
H.  died  finally  on  the  31st  of  August,  1856,  poisoned  by 
arsenic.  S.  was  accused  and  brought  before  the  tribunal  at 
Stockholm  and  acc]uitted  for  want  of  proof.  Three  years  later 
the  civil  tribunal  of  the  Seine  thre^y  aside  the  policy  of  insur- 
ance, and  exonerated  the  company  from  all  payment. 

It  occasionally  happens  that  the  religious  faith  of  the  insured 
person  is  questioned,  for  tlie  purpose  of  proving  his  sense  of 
moral  responsibility.    (Sec  Appendix  I.) 

BouMful  Cases. — In  disputed  cases  of  suicide  in  this  con- 
nection we  must  carefully  investigate  the  history  of  the 
patient's  previous  life,  his  behavior  for  a  short  time  before 
the  deed,  and  his  treatment  of  his  family.  It  need  not  fol- 
low that  every  insured  man  who  has  a  policy  and  commits 
suicide  does  so  for  tlie  purpose  of  getting  money  for  his 
family.  Where  suicide  is  committed  by  such  a  person  under 
the  influence  of  a  delusion  of  an  entirely  extraneous  character, 
or  where  it  does  not  appear  that  the  question  of  gain  enters  at 
all,  there  can  be  no  dispute  as  to  the  fact  that  the  policy  should 
be  paid,  any  more  than  if  he  died  of  any  ordinary  disease,  even 
though  he  has  signed  a  policy  which  contains  a  clause  such  as 
is  found  in  those  of  nearly  every  company.  Hereditary  influ- 
ences and  other  causes  for  which  he  is  not  responsible,  may 
produce  such  a  mental  perversion  as  to  completely  destroy  the 
individual's  sense  of  right  and  wrong  and  his  voluntary  con- 
trol. It  happens  from  time  to  time  thnt  persons  who  are 
insured  for  large  amounts  die  very  suddenly  after  the  policy 
has  been  taken  out,  under  circumstances  which,  to  say  the 
least,  are  suspicious.     But  here,  too,  it  does  not  do  to  be  too 


SUICIDE.  297 

precipitate  in  the  formation  of  an  opinion,  or  too  hasty  in  ex- 
pressing it.  A  celebrated  case  was  tested  some  years  ago  in  an 
interior  town  of  this  state,  and  although  it  was  shown  that  the 
insured,  who  had  taken  a  policy  upon  his  life  of  over  $100,000, 
had  been  a  few  months  before  financially  embarrassed  to  a 
serious  extent,  and  died  after  a  few  days'  illness  ;  no  causes 
other  than  those  of  a  natural  character  could  be  found  for  his 
death,  notwithstanding  a  most  searching  post-mortem  examina- 
tion was  made,  at  which  the  physicians  of  both  sides  were 
present.  In  this  case  all  manner  of  reasons  were  assigned  for 
the  gentleman's  rather  sudden  demise  by  the  opposing  side, 
and  it  was  even  held  that  he  had  choked  himself  to  death  by 
means  of  a  piece  of  rope.  However,  no  evidences  of  asphyxia 
were  found,  and  the  crease  which,  strangely  enough,  some  of 
the  medical  men  present  found  about  his  throat,  was  proved 
beyond  doubt  to  be  due  to  accident.  In  some  cases  when 
no  satisfactory  cause  of  death  can  be  determined,  we  should 
at  as  early  a  moment  as  practicable  determine  by  every  means 
in  our  power  the  condition  of  the  abdominal  and  thoracic 
organs,  as  well  as  of  the  brain,  for  sometimes  where  no  appar- 
ently sufficient  lesion  can  be  detected  to  account  for  the  death 
a  further  search  may  disclose  a  minute  clot  either  in  the 
medulla,  or  a  lesion  may  exist  on  other  parts  of  the  brain, 
which  may  be  at  first  confused  with  post-mortem  changes. 

It  sometimes  happens  that  frauds  are  perpetrated  upon  the 
insurance  companies,  that  dead  bodies  are  procured  and  so 
placed  as  to  lead  to  the  suspicion  that  suicide  has  been  com- 
mitted, the  companies  being  deceived  as  to  the  person's 
identity.  I  refer  the  reader  to  works  of  a  larger  scope  in 
which  the  examination  of  the  dead  is  considered. 

From  time  to  time  the  question  arises,  whether  a  man  who 
commits  suicide  for  the  purpose  of  escaping  some  hopeless 
physical  infirmity  annuls  his  policy  in  so  doing.  In  the  case  of 
"  Isett  vs.  The  American  Insurance  Company "  this  was  the 
case,  and  the  jury  were  told  that  they  must  find  a  verdict  for 
the  company,  if  they  were  convinced  that  the  suicide  was 
aware  of  the  fact  that  the  discharge  of  a  pistol  in  his  hands 
would  produce  his  death,  even  though  he  destroyed  his  life  be- 
cause he  was  desirous  of  escaping  some  physical  infirmity.  Chief 
Justice  Miller  in  his  charge  laid  down  the  principle,  that  "  it  is  not 
every  kind  or  degree  of  insanity  which  will  so  far  excuse  the 
party  taking  his  own  life  as  to  make  the  company  insuring  him 
liable.  To  do  this  the  act  of  self-destruction  must  have 
been    the   consequence    of    insanity,   and    the    mind  of    the 


29S  MEDICAL    JURISPRUDENCE. 

deceased  must  have  been  so  deranged  as  to  have  made 
him  incapable  of  using  a  rational  iudgnxent  in  regard  to 
the  act  he  was  committing.  If  he  was  impelled  to  act 
by  an  insane  impulse  which  the  reason  which  was  left  to 
him  did  not  enable  him  to  resist,  or  if  his  reasoning  powers 
were  so  overthrown  by  his  mental  condition  that  he  could  not 
exercise  his  reasoning  faculties  on  the  act  he  was  about  to  do, 
then  the  company  was  liable.  On  the  other  hand,  there  is  no 
presumption  of  \?c^  prhiia  facie  otherwise  that  self-destruction 
arises  from  insanity  ;  and  if  you  believe  from  the  evidence  that 
the  deceased,  although  excited  or  angry  or  distressed  in  mind, 
formed  a  determination  to  take  his  own  life,  because  in  the 
exercise  of  his  usual  reasoning  faculties  he  preferred  death  to 
life,  then  the  company  is  not  liable,  because  he  died  by  his  own 
hand  within  the  meaning  of  the  policy." 

In  regard  to  the  punishment  of  those  who  unsuccessfully 
attempt  suicide,  we  must  be  governed  entirely  by  the  circum- 
stances which  surround  the  commission  of  the  important  act, 
and  if  we  find  that  its  attempted  execution  is  such  as  to  sug- 
gest an  abnormal  degree  of  moral  depravity  or  eccentricity,  a 
great  doubt  of  the  sanity  of  the  would-be  suicide  must  natu- 
rally arise.  I  do  not  think  there  can  be  any  doubt  that  where 
the  subject  resorts  to  sensational  and  odd  methods,  this  view 
of  the  case  is  the  right  one.  In  such  cases  as  that  which 
occurred  in  Kentucky  a  few  years  ago,  Avhere  the  individual 
spent  several  days  and  much  labor  in  the  preparation  of  a 
guillotine,  and  afterwards  hired  a  room  in  the  hotel,  where  he 
shut  himself  up  and  was  found  decapitated,  the  manner  in 
which  the  suicide  was  consummated  suggested  irresponsibility 
upon  the  part  of  the  victim.  Suicides  for  notoriety,  examples 
of  which  I  have  detailed,  belong  to  this  class.  A  case  in 
which  no  doubt  of  the  patient's  mental  condition  should  arise, 
is  recorded  in  a  French  journal  of  a  man  who,  discovering  that 
his  mistress  was  unfaithful  to  him,  called  his  servant  to  him, 
and  told  him  that  he  intended  to  kill  himself,  expressing  the 
wish  that  after  his  death  his  fat  should  be  converted  into  a 
candle,  which  should  be  lit  and  carried  to  his  mistress.  He 
then  wrote  a  letter,  in  which  he  told  her  that  as  he  had  long 
burned  for  her,  she  might  now  see  that  his  flames  were  real, 
for  the  candle  by  which  she  read  the  note  was  composed  of 
his  miseral)le  body.  After  this  he  committed  suicide,  Wins- 
low,  who  mentions  this  case,  refers  to  that  of  a  blacksmith, 
who  charged  an  old  gun  barrel  with  a  brace  of  bullets,  and, 
putting  one  end  in  the  fire  of  his  forue.  tied  a  string  to  the 


SUICIDE.  299 

handle  of  his  bellows,  by  pulling  which  he  could  make  them 
play  whilst  he  was  at  a  convenient  distance  ;  kneeling  down  he 
then  placed  his  head  near  the  mouth  of  the  barrel,  and 
moving  the  bellows  by  means  of  the  string  they  blew  up  the 
fire,  he  keeping  his  head  with  firmness  and  horrible  de- 
liberation in  that  position  till  the  further  end  of  the  fire 
was  so  hot  as  to  kindle  the  powder,  whose  explosion  drove  the 
bullets  through  his  brain.  There  are  numerous  cases  of  this 
kind,  which  might  be  narrated,  but  are  out  of  place  in  these 
pages. 

The  examples  which  interest  us  especially  in  regard  to  the 
punishability  of  the  individual  are  those  where  the  person  at- 
tempts his  life  to  escape  ill  health,  disgrace,  impending  finan- 
cial ruin,  and  poverty.  These  are  too  common  to  need  more 
than  cursory  mention,  and  it  cannot  be  denied  that  nearly  al- 
ways they  are  the  result  of  a  low  moral  tone,  which  does  not 
bring  with  it  any  suspicion  of  irresponsibility.  Prompt  and 
vigorous  punishment  is  the  most  effectual  remedy  ;  and  espec- 
ially is  this  the  case  where  the  suicide  is  one  of  a  number  oc- 
curring in  the  course  of  what  may  be  called  an  epidemic. 
The  low  grade  of  moral  courage  which  springs  perhaps  from 
slight  physical  suffering,  which  the  individual  does  not  fight 
against,  and  a  loose  mode  of  living,  lacking  the  restraints  of 
wholesome  self-discipline,  make  this  crime  fearfully  com- 
mon, and  undoubtedly  lead  to  a  disregard  of  the  value  of 
human  life,  which  in  other  individuals  takes  the  form  of  homi- 
cide. 

Responsibility  of  Suicides. — The  humane  views  of 
Winslow  are  certainly  too  sentimental  to  meet  the  requirements 
of  the  society  of  to-day,  and  his  apology  for  the  suicide  belongs 
to  an  age  when  almost  every  sj^ecies  of  wickedness  was  condoned 
and  explained  by  moral  insanity.  I  quite  agree  with  Beccaria, 
that  any  punishment  "  which  does  not  come  from  absolute  ne- 
cessity is  unjust,"  and  that  crimes  are  only  to  be  estimated  by 
the  injury  done  to  society,  and  that  the  end  of  punishment  is 
to  prevent  the  criminal  from  doing  further  injury,  as  well  as  to 
induce  others  to  refrain  from  committing  similar  offenses. 
Winslow's  view  is  that  "the  unfortunate  individual  by  the  very 
act  of  suicide  places  himself  beyond  the  vengeance  of  the  law  ; 
he  has  anticipated  its  operation  ;  he  has  rendered  himself  amen- 
able to  the  highest  tribunal,  namely  :  that  of  his  Creator  ;  no 
penal  enactments,  however  stringent,  can  affect  him."  This 
statement   cannot  apply   to  all  cases,  as  I  have    shown  by  the 


300  MEDICAL   JURISPRUDENCE. 

examples  where  the  attempt  has  been  made  to  defraud  insur- 
ance companies  ;  and  it  cannot  be  denied  that  there  is  a  large 
number  of  individuals  whose  motives,  while  not  those  of  men 
of  good  judgment  or  sound  sense,  are  almost  the  same  as  those 
of  criminals  who  murder  for  petty  sums,  or  who  steal  for  the 
purpose  of  having  themselves  fed  and  sheltered  in  a  prison. 


CHAPTER  VII. 


CRANIAL    INJURIES. 


Preliminary  Anatomical  Considerations.  The  Skull. 

—  The  skull  may  be  roughly  described  as  "  an  egg-shaped  case 
with  a  flattened  under  surface,  the  forepart  of  which  gives  attach- 
ment to  the  face.  The  sides,  the  top,  and  the  back  of  the  case  are 
formed  by  flat  bones,  consisting  for  the  most  part  of  two  layers, 
an  outer  and  an  inner  table,  with  spongy  tissues  known  as  dip- 
loe  between  them  ;  but  where  the  walls  are  very  thin  there  is 
but  a  single  layer.  The  vault  of  the  skull  presents  but  two 
minute  and  inconstant  openings,  the  parietal  foramina,  for  the 
passage  of  small  veins  ;  but  the  base  contains  many  openings 
and  is  of  quite  a  different  structure  ;  in  parts  of  it  the  bones 
are  hollowed  into  mere  shells,  forming  chambers  communicat- 
ing with  the  pharynx  and  lined  with  mucous  membrane  ;  in 
parts  the  bones  contain  cancellated  tissue,  such  as  is  found 
elsewhere,  and  again  parts  are  made  of  solid  bone.  The  base 
is  decidedly  the  weakest  part.     (Dwight.) 

The  membranes  of  the  Brain. — Within  the  interior  of 
the  cranium  is  the  brain,  composed  of  the  cerebrum  and  the 
cerebellum,  beneath  which  lie  the  pons  and  medulla,  and  these 
are  practically  surrounded  by,  three  membranes,  the  thickest 
and  coarsest  of  which  is  the  dura  jnater,  which  lies  next  the 
bony  surface  of  the  cranium,  and  which  is  prolonged  in  broad 
folds  forming  supports  for  the  soft  structures  which  it  encloses, 
there  being  a  longitudinal  extension  between  the  two  hemi- 
spheres of  the  cerebrum,  (falx  cerebri),  and  we  find  at  right 
angles  to  the  falx  another  prolongation  which  dips  transversely 
downwards  forming  a  partition  between  the  posterior  lobes  and 
the  cerebellum,  (tentorium).  A  small  fold  in  the  median  line 
runs  from  the  posterior  surface  of  the  tentorium  to  the  for- 
amen magnum. 

The  Sinuses. — Running  through  the  membrane  are  several 
important  canals  or  sinuses  which  receive  the  venous  blood  and 
meet  at  the  base  of  the  skull  communicating  with  the  jugular 


302  MEDICAL  JURISPRUDENCE.  > 

veins  principally.     This  membrane  is  tough  and   resilient   and 
admirably  protects  the  i  \:rvous  organs. 

The  dura  mater  is  plentifully  supplied  by  nerves  from  the 
fifth  pair,  from  the  pneumogastric,  from  the  third,  and  it  also 
receives  sympathetic  fib'^e.'^, 

The  pain  in  meningitis,  therefore,  arises  from  involvement 
of  ihe  first-named  nerve,  and  the  choked  disk  so  common  with 
meningeal  affections  is  due  to  lesion  of  the  recurrent  branch  of 
this  nerve  as  well. 

Araclllioid. — Beneath  the  dura  mater  is  the  arachnoid, 
which  covers  the  convolutions  and  contains  spaces  for  the 
accumulation  ot  ccrebro-spinal  fluid  ;  that  beneath  the  arach- 
noid being  called  the  sub-arachnoid  space,  and  that  outside  the 
sub-dural  space. 

Pia  Mater. — The  most  delicate  of  the  three  membranes  is 
the  pia  mater ^  which  immediately  invests  the  brain  and  contains 
in  its  meshes  a  very  great  number  of  small  arteries  and  veins 
which  are  concerned  principally  in  the  blood  supply  of  the 
cortex. 

It  would  be  going  too  deeply  into  the  subject  to  minutely 
describe  the  anatomy  of  this  membrane  ;  suffice  it  i  ■>  say  that 
it  is  reflected  at  various  situations  into  the  substance  of  the 
brain,  forming  at  different  points  the  choroid  plexus,  the  velum 
interpositum,  and  it  ramifies  in  other  directions  to  form  the 
walls  of  the  fourth  ventricle,  and  to  enter  the  lateral  ventricles. 

Tlie  Ceretoriim. — The  cerebrum  is  composed  of  two  hemi- 
spheres and  has  an  external  investment  of  gray  nervous  mat- 
ter rich  in  cells  and  having  sensory  functions  of  a  higher  kind, 
and  bloodvessels  and  an  internal  collection  of  white  matter 
composed  of  conducting  fibres  bound  together  by  connective 
tissue,  these  fibres  passing  downwards  through  and  between 
large  bodies  composed  of  gray  matter  and  reinforced  by  other 
fibres  from  the  cerebellum  pass  below,  partially  crossing  in 
the  medulla  oblongata,  the  conductors  from  one  hemisphere 
going  in  part  to  the  opposite  side  of  the  body  and  vice  versd. 

The  Gray  Matter. — The  investing  layer  of  gray  matter 
or  cortex  has  been  found  to  have  various  ])sycho-motor  func- 
tions which  are  seated  in  circumscribed  areas  in  the  different 
convolutions  of  the  brain.  The  most  important  of  these  is  the 
speech  center  located  anteriorly,  laterally  and  near  the  lower 
part  of  the  brain  in  the  third  frontal  convolution.  About  the 
fissure  of  Rolando  which  runs  from  the  great  longitudinal  fissure 


CilANIAL   INJURIES.  3°^ 

downwards  towards  the  fissure  of  Sylvius  are  centers  which  pre- 
side over  the  movements  of  the  arms,  legs,  certain  muscles  of  the 
face  and  eyes  ;  and  in  the  angular  gyrus  there  is  one,  injury  of 
which  results  in  blindness.  There  are  other  centers  situated 
at  the  lower  surface  of  the  brain  concerned  in  taste  and  smell. 
Injury  of  the  cortex  at  other  points  may  give  rise  to  very 
little  trouble.  But  when  the  above-mentioned  centers  are 
involved  we  are  furnished  either  with  limited  convulsions,  par- 
alyses or  sensory  disturbances. 

When  the  masses  of  gray  matter  situated  at  the  bas°  of  the 
brain  are  affected  by  injury  or  disease,  very  important  altera- 
tions of  function  are  manifested,  and  a  limited  lesion  will 
cause  extensive  disturbance. 

The  White  Matter. — The  white  matter  or  conducting 
substance  is  much  more  tolerant,  and  very  extensive  disorgan- 
ization may  exist  without  any  corresponding  loss  of  function. 

The  Medulla  OMong-ata.— Posteriorly  and  beneath  the 
brain  is  a  small  mass  of  nervous  tissue,  the  medulla  oblongata, 
in  which  arise  many  of  the  cranial  nerves  ;  and  injury  here  is  apt 
to  be  followed  by  important  forms  of  paralysis  of  the  organs  of 
the  face,  or  by  death  as  the  result  by  reason  of  the  disturbance  or 
abolition  of  function  of  the  pneumogastric  nerve  which  plays  so 
important  a  part  in  the  innervation  of  the  heart  and  other  organs. 

The  Cerebellum. — The  cerebellum  is  situated  behind 
and  beneath  the  cerebrum,  and  is  composed  of  gray  and  white 
matter,  and  it  has  been  found  that  injury  or  disease  of  this 
body  is  apt  to  be  followed  by  pain,  inco-ordination  of  move- 
ment, vomiting  and  visual  disturbances. 

The  above  brief  description  of  the  coarse  anatomy  of  the 
brain  is  but  fragmentary,  and  the  reader  is  referred  to  any  of 
the  treatises  upon  neurological  subjects  for  more  explicit  infor- 
mation. 

Subjective  Symptoms.— The  chief  subjective  symptom 
of  head  injury  is  that  of  pain  which  is  diffused  or  localized.  It 
varies  from  the  slight  ache  which  follows  the  course  of  the 
eyes  to  the  tearing,  violent  agony  of  meningitis  or  irritation.  In 
cerebral  abscess  it  is  often  intense  and  accompanied  by  throb- 
ing,  while  mental  labor,  or  causes  which  favor  determination  of 
blood  to  the  head,  increases  all  varieties  of  pain  having  this 
region  for  its  seat.  Neuralgia  is  far  less  common  than  some 
undefined  forms,  but  a  not  unusual  symptom  of  concussion 
especially  is  the  existence  of  vagrant   flying  pains  which  are 


304  MEDICAL   JURISPRUDENCE. 

neuralgic  in  character.  A  sense  of  pressure  over  the  orbit  is 
quite  frequently  the  source  of  complaint,  while  sub- occipital  or 
mastoid  pain  is  of  common  origin  in  basal  fracture,  meningitis, 
and  lesion  the  result  of  contrecoup. 

We  often  find  as  a  result  of  cranial  injuries  certain  spinal 
symptoms  which  may  occur  either  from  transmitted  violence,  or 
from  an  extension  of  an  inflammation  lighted  up  at  the  point 
of  injury. 

Ocular  Symptoms. — These  are  of  a  most  variable  kind, 
and  the  muscles  of  the  eyeball  or  the  fundus  of  the  eye  may  be 
affected.  In  meningitis,  or  in  disease  attended  by  effusion  of 
serum  or  pressure  changes  there  may  be  well  marked  choked 
disk.  In  softening  the  signs  of  optic  neuritis  are  quite  common 
and  in  association  with  sclerosis  of  the  brain  consecutive  to 
co7nmotio  cereb7-i  we  find  atrophy  of  the  optic  disk. 

In  case  of  general  compression  the  pupils  will  be  dilated,  or 
if  the  pressure  be  partial  and  confined  to  one  side  we  will  find 
the  pupil  of  that  side  dilated. 

The  Differential  Diagnosis  of  Concussion  and  Com- 
pression by  tJse  OpIltlialmOSCOpe. —  Bouchut  claims  that 
ophthalmoscopic  examination  is  the  most  certain  way  of  de- 
termining the  difference  between  concussion  and  compression 
of  the  brain.  If  concussion  only  exists,  there  are  no  abnormal 
appearances  presented. 

"  In  contusions  of  the  brain,  on  the  other  hand,  with  or 
without  consecutive  inflammation,  as  well  as  in  the  case  of 
serous  or  hemorrhagic  effusion  into  the  cavity  of  the  cranium, 
symptoms  of  a  more  or  less  intense  congestion  are  observed  in 
the  neighborhood  of  the  ophthalmic  vessels,  since  the  disturb 
ance  of  circulation  within  the  skull  is  necessarily  transmitted 
hither.  The  optic  nerve  is  swollen,  appears  flattened,  uniformly 
reddened,  sometimes  more  intensely  injected.  Its  contour  is 
less  sharp,  and  it  is  the  seat  of  serous  swelling,  which,  passing 
over  the  neighboring  portions  of  the  retina,  covers  the  border 
of  the  papilla  to  a  greater  or  less  degree.  From  these  symptoms 
Bouchut  was  enabled,  in  four  cases  cited,  to  establish  a 
certain  diagnosis  which  the  other  clinical  symptoms  had  failed 
to  make  good." 

Sometimes  ocular  disturbances  of  previous  existence  may  be 
improperly  referred  to  the  particular  accident. 

In  Page's  table  appears  this  case  in  which  ocular  symptoms 
were  alleged  to  have  followed  a  concussion  received  in  a  rail- 
road accident. 


CRANIAL  INJURIES.  305 

"  Male  patient,  aged  14.  Stunned  by  severe  wound  and 
blow  over  left  eyebrow.  In  bed  fourteen  days  having  much 
pain  in  head.  When  he  began  to  move  about  he  found  he 
could  not  see  so  well  as  before  with  his  left  eye,  although  for 
a  fortnight  he  had  been  able  to  see  quite  well.  Right  eye 
lost,  but  not  removed,  four  years  before  from  blow.  Examina- 
tion of  left  eye  revealed  distinct  evidences  of  old  choroido- 
retinitis.  Without  going  into  all  the  pathological  changes 
discovered,  the  conclusion  arrived  at  was  that  the  earlier 
attacks  had  been  very  mild,  and  being  peripheral  had  caused 
no  noticeable  change  of  vision,  and  that  the  shock  of  the 
blow  had  aggravated  the  disease  and  favored  the  occur- 
ence of  opacities  in  the  vitreous.  All  parts  of  the  equator 
were  equally  affected,  which  seemed  to  be  against  the  likeli- 
hood of  the  changes  having  been  solely  produced  by  concus- 
sion. 

"Date  of  settlement  12  months  after  the  accident.  Last 
heard  of  4.%  years  after  accident.  Condition  then — general 
health  good  ;  eyesight  unchanged.  No  evidence  of  injury  to 
spinal  cord  or  membranes." 

Kind  and  Direction  of  Yiolence. — Guthrie  has  shown 
that  violence  applied  to  the  front  part  of  the  head  is  much 
more  apt  to  be  attended  by  serious  results  than  when  the  force 
is  applied  elsewhere,  a  fact  confirmed  by  Crichton  Browne* 
and  others. 

"Injury  to  the  forehead,"  says  Browne,  "is  exceedingly 
perilous  ;  injury  to  the  side  of  the  head  less  so,"  but  he  differs 
from  Guthrie  believing  that  the  injury  to  the  back  of  the  head 
is  almost  as  hazardous  as  in  front.  Our  knowledge  of  cerebral 
physiology  teaches  us  that  in  the  middle  and  anterior  part  of 
the  brain  are  exceedingly  important  centers  which,  when  the 
seat  of  injury  or  disease  are  apt  to  be  followed  by  various  dis- 
turbances of  important  functions.  Of  course  there  are  ex- 
ceptions, and  I  have  known  of  several  cases  where  large  parts 
of  the  anterior  lobes,  or  tracts  of  the  cerebral  cortex  were 
destroyed  without  the  production  of  any  lesion  whatever.  One 
case  I  can  recall  was  brought  to  the  New  York  Hospital — a  young 
man  who  had  fallen  upon  his  head,  fracturing  the  temporal  and 
parietal  bones,  and  there  was  a  depression  of  the  fragments 
deep  into  the  region  which  is  divided  by  the  fissure  of  Rolando. 
When  the  bones  were  elevated  large  masses  of  cerebral  sub- 
stance were  injured  and  torn,  and,  strange  to  say,  no  paralysis 

*  West  Ridins  Reports.  Vol.  ii.    d.  qq. 


3o6  MEDICAL   JURISPRUDENCE. 

followed.  Large  masses  of  the  anterior  lobes  have  been 
removed  vv^ithout  peril  to  the  patient,  and  the  celebrated  Massa- 
chusetts case  in  which  one  frontal  lobe  was  destroyed  by  pre- 
mature blast  and  the  passage  of  the  "  tamping  iron  "  through 
the  skull  is  of  this  kind.  Guthrie  has  told  us  that  splinters  of 
bone  of  considerable  size  may  be  lodged  in  the  posterior  part 
of  the  brain  without  detriment.  It  would  be  going  too  deeply 
into  the  field  of  neuro-pathology  to  consider  fully  the  symptoms 
that  follow  special  injuries,  but  it  may  be  stated  that  as  the  re- 
sult of  direct  injury  and  contrecoup  a  variety  of  changes  may  be 
produced. 

Contrecoup. — In  four  marked  cases  of  the  latter  injury 
at  the  West  Riding  Asylum,  where  the  force  of  a  blow  upon 
one  part  of  the  skull  was  transmitted  to  a  point  opposite — 
"  severe  epilepsy  with  dementia  has  been  noticed  as  the  conse- 
quence of  a  fracture,  with  depression  of  the  skull,  or  violent 
blow  at  the  upper  part  of  the  frontal  bone  at  a  point  as  nearly 
as  possible  opposite  to  the  medulla  oblongata."  Browne  is  in- 
clined to  attach  much  importance  to  blows  in  the  frontal  region 
as  a  cause  of  epilepsy  and  epileptic  dementia.  So  far  as  my 
personal  experience  goes  I  am  inclined  to  believe  that  there  is 
a  site  which  is  more  important.  Blows  over  the  fronto- 
parietal region  are,  I  think,  a  fruitful  cause  of  epilepsy. 

Yarieties  of  Injury. — Much  depends  upon  the  force  and 
direction  of  the  blow  and  the  region  injured.  Quick  localized 
blows  are  less  apt  to  produce  contrecoup  than  diffused  force. 
Comparatively  light  blows  may  produce  extensive  injuries. 
More  or  less  general  symptoms  are  : 

1.  A  fracture  and  pressure  upon  the  membrane  and  brain 
substance. 

2.  Concussion  and  diffused  lesion. 

3.  Contrecoup  and  resulting  lesions. 

4.  Meningitis  as  a  result  of  force  applied  externally  without 
fracture. 

Fracture  of  the  Skull. — Fractures  of  the  skull  are 
common  and  the  resulting  symptoms  are  of  the  most  variable 
kind.  Holmes  divides  cranial  fractures  into  those  of  the 
vault  and  those  of  the  base  ;  and  there  is  another 
division  which  includes  the  comjjlicated  cases.  We  find 
that  fractures  of  the  vault  arc  direct,  and  that  there  is 
usually  a  simple  fissure  or  comminution  ;  but  the  former  is 
more  apt  to  extend  than  the  latter.  There  is  displacement  in- 
wards of  the  fragments  to  a  variable  degree  ;  and  it  does  not 


CRANIAL   INJURIES.  307 

follow  that  both  tables  need  be  depressed  ;  and  the  inner  may 
be  the  seat  of  the  fracture,  while  the  outer  table  remains  un- 
harmed. Sliarp  blows  witli  pointed  instruments  are  apt  to  pro- 
duce such  fractures.  There  is  much  variation  in  tlie  position 
of  the  fragments  ;  sometimes  they  are  depressed  in  the  center 
and  splintered,  and  Holmes  refers  to  a  form  of  fracture  in 
which  the  depression  was  caused  by  an  "  oval  piece  of  bone, 
which  was  not  only  driven  down,  but  split  longitudinally  in 
two  fragments  which  slanted  towards  each  other,  the  depression 
being  much  greater  at  the  center  than  at  the  circumference." 
"  Such  a  fracture  is  commonly  produced  by  some  heavy  body 
with  a  sharp  margin  applied  with  great  force,  as  a  horse-shoe." 
The  most  ordinary  form  of  fracture,  according  to  Holmes,  is 
that  where  the  fragments  depressed  are  triangular,  their  points 
being  pressed  downwards  and  their  bases  even  with  the  surface 
of  the  skull.  Fractures  of  the  base  are  usually  the  result  of 
falls,  the  patient  very  commonly  alighting  upon  his  feet,  and  they 
are  generally  limited.  We  find  very  often  that  the  middle  part,  of 
the  petrous  portion  of  the  temporal  bone,  and  those  parts  lying 
immediately  in  front  of  the  foramen  magnum  are  most  com- 
monly injured,  while  those  posteriorly  situated  are  next  in 
order,  and  fractures  of  the  anterior  parts  come  last.  There  are 
certain  parts  that  are  very  susceptible  to  injury  and  fracture, 
the  basilar  process  of  the  occipital  bone,  the  wings  of  the 
sphenoid  and  the  orbital  plate  of  the  frontal  suffering  from 
comparatively  slight  violence.  When  the  bones  about  the  fora- 
men magnum  and  just  anterior  to  it  are  found  fractured,  it  is 
quite  possible  that  the  pressure  has  been  brought  to  bear 
antero-posteriorly. 

Undetected  Fractures.— Fractures  of  the  skull  may  often 
remain  undetected  during  the  life  of  the  individual,  and  with 
the  production  of  very  slight  symptoms,  this  being  especially 
the  case  when  the  vault  is  affected.  An  interesting  case  illus- 
trating the  mistakes  in  diagnosis  that  may  arise  through  the 
carelessness  of  the  examining  surgeon,  but  one  most  unique  in 
its  way,  is  that  "of  a  woman  who  was  admitted  into  the  Hotel 
Dieu,  with  a  wound  in  the  temporal  region,  accompanied  by  a 
profuse  bleeding.  A  fragment  of  bone  several  lines  in  length 
was  found  deep  in  the  wound,  and  quite  loose.  This  was  re- 
moved, and  the  finger  then  passed  through  an  opening,  the  cir- 
cumference of  which  was  unyielding.  The  case  was  at  once 
thought  to  be  one  of  compound  fracture,  with  the  separation 
of  some  fragments,  but  it  was  soon  remarked  by  a  by-stander 


30Ji  MEDICAL   JURISPRUDENCE. 

that  the  fragment  of  bone  removed  was  dry  and  quite  white  as  if 
it  had  been  macerated.  This  led  to  a  more  careful  examina- 
tion of  the  wound,  and  it  was  discovered  that  the  supposed 
hole  in  the  skull  was  nothing  but  a  laceration  of  the  temporal 
fascia,  and  the  fragment,  the  innocent  cause  of  the  error, 
turned  out  to  be  simply  a  piece  of  bone,  which,  lying  on  the 
ground,  had  been  driven  into  the  temple  when  the  patient  fell." 

Injury  of  Cranial  Nerves  as  a  Result  of  Fracture. 

Injury  of  the  cranial  nerves  is  not  an  uncommon  accident  in 
connection  with  partial  fractures.  We  frequently  meet  with 
deafness  as  a  result  of  fracture  at  the  base  and  various  symp- 
toms indicative  of  local  nerve  traumatisms  are  to  be  found  di- 
rectly after  a  serious  cranial  injury.  When  the  fifth  pair  is 
involved  the  symptoms  maybe  like  those  of  the  following  case, 
reported  by  Holmes  : 

"A  man,  aged  35,  having  the  day  before  been  buried  by 
some  earth  falling  upon  him,  was  admitted  into  \\\q  Hopital  St. 
Antoine,  in  June,  1854,  in  a  state  of  perfect  insensibility,  and 
with  such  profuse  bleeding  from  the  nose  that  it  became  neces- 
sary to  plug  his  nostrils.  The  ocular  conjunctiva,  especially 
on  the  left  side,  was  distended  with  blood,  and  so,  too,  were 
the  eyelids.  He  gradually  recovered  and  then  paralysis  of 
various  nerves  became  evident  at  different  periods.  The  right 
upper  lid  and  eyeball  lost  all  power  of  motion.  A  few  days 
afterwards  and  paralysis  of  the  right  side  of  the  face  was  ob- 
served. It  was  not  quite  complete,  but  both  sensation  and 
motion  were  manifestly  affected.  Ten  days  after  the  patient 
had  been  in  the  hospital,  the  conjunctiva  of  the  right  eye  was 
oedematous  and  much  chemosed  ;  the  cornea  could  be  touched 
freely  without  flinching  ;  it  had  lost  some  of  its  transparency 
and  at  its  lower  part  there  was  a  yellow  spot  like  an  interlamel- 
lar  abscess.  Towards  the  end  of  the  month  the  cornea  pre- 
sented a  slight  ulceration  opposite  to  the  yellow  spot  and  the 
facial  paralysis  was  even  more  marked.  Matters  went  on  much 
in  the  same  way  during  the  month  of  July,  with  more  ulcera- 
tion, however,  about  the  eye  and  less  paralysis  of  the  face. 
Early  in  August  the  cornea  gave  way,  and  the  aqueous  humor 
escaped.  Later  on  in  the  month  the  patient  began  to  improve. 
Subsequently  the  right  cornea  cicatrized  and  he  could  see  from 
the  up])er  part,  and  ultimately  both  sensation  and  motion  were 
restored  to  the  right  side." 

Concussion. — Concussion  of  the  brain  is  apt  to  produce 
a   general  disturbance  of  function. — The   shock  may  be    fol- 


CRANIAL    INJURIES.  309 

lowed  by  unconsciousness,  vertigo,  confusion  of  ideas,  with 
nausea  and  vomiting  perhaps,  dilatation  of  the  pupils,  chilliness 
of  the  surface  and  a  weak,  small  pulse. — This  may  pass  off 
leaving  the  patient  nervous  and  irritable  and  perhaps  with 
headache — or  it  may  be  followed  by  severe  cerebral  disturb- 
ances, the  result  of  an  ensuing  cerebritis. — The  after-symptoms 
may  develop  most  insidiously.  A  slight  concussion  may  pro- 
duce few  or  no  effects  but  within  a  variable  time,  from  a  few 
hours  to  several  days,  an  alarming  train  of  nervous  symptoms 
arises  which  deepens  until  the  patient  finally  presents  all  the 
evidence  of  cerebral  softening. — The  Commotio  cerebri  of  cer- 
tain writers  is  a  condition  of  this  kind. 

Cerell)ral  Irritation — A  form  of  trouble  following  con- 
cussion of  a  light  grade  is  called  by  Erichsen  cerebral 
irritation.  The  patient  is  partially  conscious  and  in  a  half  dazed 
condition  with  half  or  firmly  closed  eyelids.  His  pupils  are 
contracted.  He  lies  in  a  constrained  position,  usually  upon 
his  side  with  his  thighs  and  his  legs  flexed  and  his  hands 
clenched.  The  surface  is  cool  and  the  pulse  is  slow  and  weak. 
He  may  remain  in  this  condition  for  several  weeks  before  there 
is  a  slow  return  to  the  normal  state,  and  cerebral  excitement  is 
succeeded  by  prostration  and  stupidity. 

This  condition  may  be  the  starting  point  of  serious  cerebral 
mischief  which  may  subsequently  develop  in  the  most  insidious 
manner. 

The  books  contain  many  cases  of  trivial  blows  being  fol- 
lowed by  remote  symptoms  indicative  of  transmitted  violence 
and  prominent  among  them  is  the  abolition  of  functions  of  any 
one  of  the  special  senses.  Blows  upon  the  forehead  have  pro- 
duced not  only  epilepsy  but  loss  of  smell  and  taste. 

Concussion  and  Meningitis.— Huguenin  calls  attention  to 
the  meningitis  that  may  follow  concussi@n  without  any  exter- 
nal injury.  This  is  however  not  common,  but  when  it  occurs 
is  preceded  by  the  symptoms  of  cerebral  irritation,  by  deepen- 
ing coma  and  by  great  slowness  of  the  pulse  in  the  beginning. 

Sexual  Perversion  in  Head  Injuries. — Brown-Sequard 

and  others  have  shown  that  injury  to  the  brain  is  apt  to  be  fol- 
lowed by  sexual  perversion,  loss  of  power  to  cohabit  and  local 
neuralgia.  Curling  and  other  writers  have  presented  cases  that 
prove  beyond  doubt  that  in  some  instances  head  injuries  are 
followed  by  atrophy  of  the  testicles.  Such  troubles  are 
usually  the  result  of  blows  or  falls  iipon  the  back  the  head. 


JIO  MEDICAL   JURISPRUDENCE. 

Diabetes  is  occasionally  produced  by  concussion,  but  there  is 
more  often  slight  albuminuria. 

Affections  of  Intellect  from  Head  Injuries. — Intel- 
lectual changes  of  slow  growth  often  follow  slight  shocks.  These 
are  seen  in  the  departure  from  former  habits  and  tastes, — mo- 
roseness  or  excitability,  immoral  tendencies  and  mental  weak- 
ness are  induced,  and  the  person  may  become  a  whining 
wreck.  These  changes  exist  in  a  light  degree  or  there  may  be 
actual  insanity  of  a  marked  grade.  Gall  reports  the  case  of  a 
man  who  was  injured  by  a  falling  tile  which  penetrated  the 
brain.  Before  the  accident  he  was  an  amiable  steady  man, 
afterwards  he  was  quarrelsome  and  flew  into  a  rage  at  little 
things.  Browne  reports  the  case  of  a  patient  under  his  obser- 
vation.— 

"  W.  H.  about  whom  I  was  consulted  some  time  ago,  was  a 
steady  and  respectable  tradesman  until  he  fell  from  some  steps 
while  cleaning  a  shelf  in  his  own  shop,  and  was  stunned  for  a 
few  seconds.  From  that  time  he  underwent  a  change.  He  no 
longer  attended  to  business  to  which  he  had  been  formerly  de- 
voted ;  he  speculated  and  lost  his  savings  ;  he  manifested  an- 
tipathy towards  his  wife  and  two  out  of  his  five  children,  and 
he  saw  his  whole  family  reduced  to  penury,  through  his  own 
rashness  and  neglect  without  displaying  any  compunctions. 
When  complete  pecuniary  ruin  had  been  effected  he  suddenly 
became  himself  again,  and  resumed  industrious  ways,  but  ever 
since  he  had  attacks  of  restless  exitability,  with  hatred  of  his 
wife  and  children  twice  or  thrice  a  year.  He  is  at  all  times  in- 
telligent, rational  and  free  from  delusions,  and  when  at  his  best 
j>eriod,  joins  his  relatives  in  deploring  the  sad  visitations  to 
which  he  is  liable.'" 

Condition  of  Duality. — Dr.  Charles  H.  Hughes  in  a  very 
interesting  paper'''  alludes  to  the  peculiar  mental  state  of 
duality  which  sometimes  follows  head  injuries  ;  a  condition  in 
which  one  hemisphere  apparently  fills  a  vicarious  office.  He  re- 
fers to  a  case  presented  by  Joffe  and  gives  the  main  points 
of  the  history  which  is  the  following. — "  He  was  a  married  man, 
aged  53,  healthy  in  childhood  and  youth,  in  manliood  had 
headache  and  giddiness,  was  a  soldier  14  years  ;  in  encounters 
with  smugglers,  received  several  cuts  in  the  head.  His  temper 
was  irascible,  he  was  fond  of  drink,  had  hemorrhoids  and 
constipation  for  ten  years.     Disposition  serious.     His  memory 

*  American  journal  of  Insanity,  1875. 


CRANIAL   INJURIES.  3II 

failing,  he  became  unfit  for  service  and  was  discharged  in  186  r. 
His  pecuniary  circumstances  caused  him  great  anxiety,  and  in 
the  same  year,  (1861)  he  exhibited  unmistakable  signs  of  men- 
tal disturbance.  He  continually  employed  the  expression  '  we  ' 
— '  we  will  go,' — '  we  will  run,' — '  we  will  do  it,'  etc.  The 
*  other  '  man  pulled  his  ear,  plucked  his  arm,  etc.  His  left 
arm  had  spasmodic  twitchings.  He  invited  himself  to  dine 
with  his  sister,  saying  that  the  '  other  man'  compelled  him  to 
be  her  guest.  While  eating  he  said,  '  I  have  eaten  enough  but 
the  other  has  not.'  After  the  meal  he  ran  out  of  the  house,  when 
arrested,  said  the  '  other '  was  to  blame,  he  was  doing  what 
he  could  to  make  him  stop.  Tried  to  murder  a  child,  as- 
signing a  similar  cause  for  the  attempt.  He  rolled  into  the  gut- 
ter thinking  he  was  wrestling  with  '  the  other,'  and  finally  at- 
tempted to  commit  suicide,  imagining  he  was  killing 
'  the  other.'  This  brought  him  to  the  hospital.  The  confor- 
mation of  head  was  normal,  pupils  contracted  unequally,  re- 
action to  light  in  both  limited.  Hearing  normal,  but  saw  small 
animals,  insects,  etc.,  with  left  eye,  and  vision  dim  in  right 
eye.  Tearing  pains  in  left  ear  and  side  of  face.  Physiognomy 
anxious  and  expressive  of  suffering.  Skin  dry  and  tempera- 
ture and  sensibility  of  body  natural.  Pulse  seventy-eight. 
Reflex  movement  to  tickling  soles  of  feet  prompt.  No  digestive 
trouble. 

*  The   other  *  person  was  in  his   left  side  under  his  skin.  He 

called  himself  the  right  D (D was  his  name,)  the  left 

D was  a  rascal  and  caused  all  his  misfortunes.  He  some- 
times presented  the  picture  of  anxiety,  dripping  with  sweat,  and 
holding  fast  his  shirt  with  both  hands,  in  order  as  he  said  to 
make  himself  stop.  He  had  violent  impulses  to  motion,  lasting 
an  hour  or  two,  occurring  several  times  in  the  course  of  six 
weeks,  which  were  probably  epileptic  or  epileptoid  seizures. 
After  conversing  some  time,  long  enough  probably  to  weary 
and  morbidly  disturb  the  sound  hemisphere,  his  ideas  grew 
confused,  and  it  was  impossible  to  gather  any  sense  from  what 
he  said. 

"  He  died  of  dysentery,  and  during  the  progress  of  the  dis- 
ease had  no  apparent  delusions.  '  The  autopsy  revealed  a 
thickened  dura  mater.  On  the  left  side  of  the  falx,  there  was 
a  lamina  of  bone  half  an  inch  long  and  a  quarter  of  an  inch 
broad.  The  membrane  along  the  course  of  the  vessels 
were  opaque,  infiltrated  with  serum  ;  their  veins  quite  full. 
Convolutions  of  the  anterior  lobes,  especially  the  left  lobe,  very, 
much  thinned  on  the  convexity — left  anterior  lobe^  half  an  inch 


312  MEDICAL   JURISPRUDENCE. 

shorter  than  the  right.  Anterior  half  of  ventricle  of  this  side 
was  adherent  and  hard.  Optic  thalamus  and  corpus  striatum 
atrophied — especially  the  latter.  Brain  moist,  anemic,  tough. 
Ependyiiia  of  the  lateral  ventricles  thickened  and  granulated, 
corresponding  to  the  thinned  convolutions  of  the  anterior  lobe. 
The  cortex  was  thinned,  and  the  adjacent  medulla  was  indur- 
ated to  the  touch.'" 

In  some  cases  the  blow  may  result  in  a  pathological  condi- 
tion of  primary  congestion  and  distension,  subsequent  ane- 
mia and  distension  of  the  perivascular  spaces,  and  a  resulting 
mental  weakness,  occurs. 

Pachy-meningitis  and  Cranial  Injuries. — Inflamma- 
tion of  the  membranes  of  the  brain  or  meningitis  may  be  con- 
fined to  the  dura  mater  (pachy-meningitisj  or  it  may  involve  all 
the  coverings  of  the  brain.  The  conspicuous  symptom  is  pain, 
which  is  localized,  perhaps,  at  first,  and  diffused  afterwards. 
It  is  dull  and  severe,  and  as  a  rule  worse  at  night.  The  pain 
is  usually  most  severe  at  the  vertex,  and  is  increased  by  intel- 
lectual work,  excitement,  heat  or  any  cause  that  will  induce 
a  determination  of  blood  to  the  head.  It  may  be  associated 
with  localized  or  general  convulsions  if  the  cerebral  tissue  be- 
neath be  involved,  and  if  the  inflammation  be  severe  or  exten- 
sive there  will  be  a  general  disturbance  of  the  intellect,  char- 
acterized at  first  by  delirium  or  mania  if  the  inflammatory  pro- 
cess be  acute,  and  afterwards  by  stupidity  and  perhaps  de- 
mentia. 

The  mental  troubles  vary  greatly,  in  some  cases  there  may 
be  only  a  slight  apathy,  loss  of  memory  and  lack  of  concentra- 
tion, which  interferes  with  the  capacity  of  the  person  to  en- 
gage in  business  or  apply  himself  in  any  way  requiring  serious 
attention. 

Sometimes  mental  disease  follows  some  years  after  head  in- 
juries, when  no  reason  exists  in  the  beginning  for  the  anticipa- 
tion of  subsequent  mischief. 

A  gentleman  consulted  me  a  few  years  ago  for  a  nervous 
trouble  that  threatened  to  ruin  him,  and  chief  among  his  symp- 
toms were  those  of  a  mental  nature.  He  had  been  well  and 
happy  until  a  year  before  I  saw  him,  and  then  he  became 
irritable,  morose,  took  unreasonable  dislikes,  and  abused  his 
family.  At  this  time  he  had  an  epileptiform  attack,  with  great 
headache,  limited  to  the  left  side  of  the  head.  His  speech 
was  embarrassed,  and  he  became  neglectful  of  his  business, 
and  constantly  made  errors  in  his  accounts.     His  left  pupil  was 


CRANIAL    INJURIES.  313 

dilated,  and  there  was  a  slight  loss  of  power  upon  the  right 
side.  His  habits  had  always  been  good,' and  there  was  no 
cause  discoverable.  Quite  accidentally  I  found  a  scar  upon 
the  left  side  of  his  head,  about  four  inches  above  the  ear,  and 
upon  questioning  him  I  found  that  ten  years  before  he  had  been 
assaulted  on  board  a  vessel.  He  had  had  but  little  suffering 
at  the  time,  and  as  he  thought  recovered  entirely.  In  this  case 
no  intimation  of  the  trouble  occurred  until  the  development  of 
the  nervous  symptoms  in  1877. 

Remarkable  Case  of  Head  Injury  with  Mental  Dis- 
turbance and  Epilepsy. — A  case  of  mental  disease,  following 
a  most  extraordinary  bullet  wound  of  the  skull,  fell  under  my  ob- 
servation two  or  three  years  ago,  and  the  miraculous  recovery 
from  the  immediate  effects  of  the  wound  are  remarkable,  and 
the  case  is  a  useful  though  rare  example  of  how  comparatively 
favorable  the  prognosis  may  sometimes  be  in  serious  wounds  of 
the  head. 


Fig.  8. 

W.  T.  S.  received  a  bullet  wound,  in  the  battle  or  the  Wil- 
derness, May  6,  1864,  which  penetrated  the  mastoid  process  of 
the  left  temporal  bone.  He  remained  insensible  only  for  an 
hour.  The  missile  was  extracted  several  hours  after,  and  was 
found  to  be  a  flattened  minie  ball.  He  was  entirely  speechless 
and  semi-conscious  for  several  days,  and  could  not  utter  a  com- 
plete sentence  for  a  month.  The  wound  discharged  pus  and 
small  fragments  of  bone,  and  there  was  an  escape  of  these  sub- 
stances from  the  meatus  as  well  for  some  time.  He  found  that 
he  was  paralyzed  upon  the  right  side,  and  he  could  not  walk 
for  a  month  after  the  accident.  About  ten  years  after  the  in- 
jury he  began  to  have  epileptic  convulsions,  which  recurred 
irregularly  every  four  or  five  months,  but  they  have  increased 
so  that   he  now  has  them  every  few  weeks,  and  they  are  pre- 


314  MEDICAL   JURISPRUDENCE. 

cipitated  by  bodily  fatigue  or  excitement,  as  well  as  by  ex- 
tremes of  temperature,  and  they  have  been  excited  by  irritation 
of  the  bottom  of  the  large  opening  which  is  now  very  con- 
spicuous. This  opening  is  found  just  back  and  beneath  the 
left  ear,  and  consists  externally  of  an  orifice  i  centimeter  in 
breadth  and  1-3- 10  centimeters  in  length  ;  at  its  inferior  border 
it  is  2-7-10  cm.  above  the  lowermost  point  of  the  mastoid  pro- 
cess. Making  a  close  examination  it  was  found  that  a  deep 
cavity  projected  inwards  3-5-10  centimetres,  having  a  diameter 
of  about  3  centimeters.     Fig.  8. 

At  its  fundus  there  was  a  granulating  surface  and  a  small 
quantity  of  pus.  The  left  side  of  the  face  was  paralyzed,  pto- 
sis of  the  left  eye  was  present,  hearing  on  the  left  side  is  com- 
pletely gone,  the  sense  of  smell  is  impaired,  and  the  tongue  when 
protruded  points  to  the  right  side.  He  has  deep  pain  all  over 
the  head,  some  impairment  of  vision  in  the  left  eye.  Tendon  re- 
flex is  increased  on  the  right  side,  and  the  dorsal  clonus  is  de- 
cidedly active.  Sensation  is  diminished  on  the  right  side  of  the 
body,  and  there  is  a  subjective  sensation  of  coldness.  His  men- 
tal condition  has  undergone  a  most  extraordinary  change,  and 
while  in  the  field  he  was  a  courageous  quiet  soldier,  he  became 
excitable,  erratic  and  lost  to  shame,  so  far  as  some  of  his  habits 
were  concerned.  He  took  to  drink,  and  his  excesses  were  much 
like  those  of  the  dipsomaniac — there  being  periodical  debauches 
during  which  he  would  commit  all  manner  of  excesses,  fre- 
quently being  arrested.  During  the  past  four  years  he  has  upon 
several  occasions  become  maniacal  and  attempted  violence.  He 
was  destructive,  and  made  assaults  upon  his  immediate  family. 
I  saw  him  two  years  ago,  and  at  my  advice  he  went  voluntarily 
to  an  asylum. 

Aifections    of  Memory    after    Cranial    Injuries. — 

Mr.  Joseph  Bell,  in  a  very  interesting  article  upon  the  loss  of 
memory  occasionally  following  cranial  injuries,  refers  to  a 
number  of  cases  where  loss  of  memory  occurred  after  very 
trivial  scalp  wounds.     He  tabulates  these  defects  as  follows  : 

"  I,  An  instantaneous  unconsciousness  ;  that  is  to  say,  loss 
of  recognition  of  one's  individuality,  followed  by  giddiness, 
stupidity,  foolish  talking,  etc.,  which  may  pass  oft"  sooner  or 
later,  but  still  is  in  immediate  relation  to  the  accident,  and 
gradually  disappears.  2.  A  set  of  phenomena  very  various  in 
nature  and  amount,  beginning  a  few  hours  after  and  depending 
on  structural  and  inflammatory  changes  in  the  cranial  con- 
tents ;    feverishness,   delirium,   dreams,    etc.,  passing  off  into 


CRANIAL  INJURIES.  315 

fever  or  lapsing  into  coma,  from  compression  ;  if  from  hemi- 
plegia, these  may  be  very  rapid  ;  if  from  meningitis,  they  may 
be  slower,  but  are  to  be  counted  by  days  and  weeks.  3.  A 
state  of  phenomena  of  a  much  lighter  and  more  dangerous 
character  ;  beginning  with  structural  changes  in  the  cranial 
contents  in  the  direction  of  atrophy  or  softening,  where  you 
may  have  delusions,  loss  of  memory,  paralysis  and  dementia." 

Bell  alludes  to  numerous  cases  where  in  addition  to  the 
above  the  patient  had  forgotten  entirely,  not  only  the  circum- 
stances connected  with  the  accident,  but  "  a  certain  length  of 
time,  varying  in  different  cases  from  minutes  up  to  hours  and 
even  days,  with  all  its  actions,  pains  and  pleasures  before  the 
accident  happened."  A  recognition  of  this  condition  of  affairs 
is  of  immense  importance  in  those  cases  where  the  testimony 
is  given  concerning  the  details  of  the  accident,  and  a  strong 
point  is  very  often  made  (and  sometimes  unjustly  admitted  in 
court)  that  the  story  of  the  patient  is  false,  because  he  can  not 
remember  the  manner  in  which  he  was  injured  or  his  behavior 
at  the  time  ;  and  it  may  perhaps  be  insisted  that  he  was  drunk, 
when  such  was  not  the  case. 

Bell  reports  the  following  example,  which  I  reproduce  : 

"  Case  I.  A.  W.,  a  very  able  and  learned  man,  nearly  50,  of 
abstemious  habits  and  in  perfect  health,  was  rendered  tem- 
porarily unconscious  (for  probably  not  above  five  minutes) 
while  receiving  two  severe  scalp  wounds  in  occipital  region  by 
upsetting  of  a  coach.  He  volunteered  to  me,  three  days  after 
the  accident,  a  question,  including  an  expression  of  surprise, 
as  to  how  I  explained  the  fact  that  he  had  lost  memory,  not  of 
what  happened  after  the  accident,  but  of  the  few  minutes 
which  had  passed  before  it. 

"  Case  2.  W.  B.,  aet.  19,  intelligent  lad  in  business,  was 
rendered  unconscious  for  about  twenty  minutes  by  a  severe 
concussion,  the  result  of  a  railway  accident.  On  coming  to 
himself,  remembers  nothing  whatever  of  accident  or  of  occur- 
rences before  it,  such  as  his  walking  down  to  the  station  and 
getting  into  carriage.  JVo^e.  This  condition  I  have  observed 
frequently  after  railway  accidents  attended  by  concussion. 
The  patients  can  neither  understand  the  mental  condition  nor 
explain  how  it  happened  to  them,  and  thus  very  often,  from 
discussing  the  prior  phenomena  with  friends  and  fellow-suffer- 
ers, having  no  distinct  recollections  of  their  own,  get  com- 
pletely confused,  contradict  themselves  in  the  witness-box, 
and  are  credited  sometimes  with  imposture,  and  sometimes 
with  shammino- 


3l6  MEDICAL   JURISPRUDENCE. 

Case  3.  A  young  miner,  who  sustained  an  extremely  severe 
and  complicated  fracture  of  vault  of  skull,  with  cerebral 
hemorrhage  and  many  days  of  unconsciousness,  on  recover- 
ing, which  he  did  completely,  found  that  though  the  accident 
happened  on  Monday  morning,  he  having  gone  to  his  work 
perfectly  sober  and  in  absolute  health,  he  had  completely  lost 
from  his  life  the  whole  Sunday,  which  he  had  spent  visiting  his 
sweetheart,  and  the  greater  part  of  Saturday  evening  and  after- 
noon. No  suspicion  of  intoxication  or  narcotics  could  ex- 
plain away  an  hour  of  his  loss. 

"  Case  4.  A  very  intelligent  foreman  in  a  brewery  fell  down 
a  deep  well,  striking  the  sides  in  his  fall,  and  having  serious 
scalp  wounds  and  concussion.  He,  on  his  recovery,  is  so  much 
puzzled  and  amazed  by  the  loss  of  memory  of  the  events 
which  preceded  the  injury,  that  he  actually  makes  guesses  at 
his  proceedings,  but  fails  to  explain  to  his  own  satisfaction,  or 
that  of  any  body  else,  what  it  was  he  was  doing  to  the  well 
and  its  rope.  This  man's  case  also  illustrates  very  well  one  of 
the  uncommon  sets  of  mental  phenomena  following  accident, 
which  I  have  classed  as  2,  depending  on  structural  or  inflam- 
matory changes,  which  are  to  be  measured  by  days.  After 
coming  out  of  his  comatose  condition,  he  for  several  days  was 
odd,  speaking  sensibly  enough,  but  with  an  uncomfortable 
plainness  of  speech  ;  as,  for  example,  he  stated  his  belief  that 
my  head  nurse  and  I  were  a  set  of  duffers  because  we  kept 
him  on  low  diet.  During  this  period  he  did  not  recognize  his 
own  wife,  nor  did  not  know  he  had  such  a  relation,  and  so  on. 

But  mark  the  difference.  All  these  delusions  are  forgotten 
on  his  recovery,  or  remembered  only  to  be  laughed  at — every 
thing  in  the  past  is  now  recalled,  except  the  lost  hour  or  two 
immediately  preceding  the  accident." 

The  mental  disturbance  which  follows  head  injury  is  some- 
times of  a  violent  kind,  and  is  manifested  in  acts  of  violence. 
Dr.  Gray  reports  the  case  of  a  man  who  killed  his  wife  about 
one  year  after  the  receipt  of  his  head  injury.  The  patient 
was  "  aged  40,  widower,  eight  children,  iron  worker,  no  educa- 
tion, uses  liquor  and  tobacco,  native  of  England,  not  heredi- 
itary.  About  a  year  before  the  homicide,  he  had  his  skull 
fractured  by  the  fall  of  some  bricks.  He  was  treated  in  the 
New  York  Hospital,  and  discharged  from  there  six  months 
before  his  admission  to  the  Asylum.  Previous  to  the  injury 
he  had  borne  a  good  character  and  was  a  mild  and  inoffensive 
man.  After  leaving  the  hospital  he  suffered  much  from  head- 
ache, of   a  severe  character,  situated  near  point  of  fracture. 


CRANIAL   INJURIES.  317 

He  lost  memory  and  became  excessively  irritable  and  violent 
if  crossed  or  opposed  in  any  way,  and  was  sleepless.  Three 
months  before  his  admission,  he  killed  his  wife  during  a  par- 
oxysm of  excitement,  by  striking  her  repeatedly  with  a  chair. 
He  was  arrested  and  lodged  in  jail,  but  denied  any  knowledge 
or  recollection  of  the  crime.  He  did  not  manifest  any  reali- 
zation of  the  occurrence  until  some  time  after,  and  when  it 
had  been  frequently  told  him.  He  was  sent  from  jail  to  the 
asylum,  on  the  order  of  the  County  Judge.  For  a  long  period 
he  suffered  from  headache  and  was  at  times  irritable,  but 
manifested  no  tendency  to  commit  violence.  He  was  emo- 
tional and  sensitive  to  the  remarks  of  other  patients  ;  although 
able  to  do  light  work,  any  unusual  exertion  or  exposure 
brought  on  a  return  of  the  headache.  He  became  more  equa- 
ble in  his  feelings,  and  feeble-minded,  remained  in  the  asylum 
four  years,  when  he  eloped.     He  has  since  died." 

The  Courts  are  not  disposed  to  recognize  what  is  legally 
known  as  "distress  of  mind" — that  is  to  say  the  annoyance 
and  discomfort  which  a  healthy  person  may  experience.  It  is, 
therefore,  important  for  the  plaintiff  to  prove  that  his  mental 
disturbance  is  the  result  of  brain  disease. 


Case  LV. — Head  Injury.  Claim  for  Damages  for  Dis- 
tress OF  Mind  not  the  Direct  Result  of  Accident. 
Denial. 

City  of  Salina  ) 

vs.  f      27  Kansas  Reports,  544. 

Prosper,       ) 

Thompson  Prosper  was  injured  on  the  night  of  April  29, 
1878,  in  the  city  of  Salina,  by  falling  through  an  excavation 
on  one  of  the  sidewalks  in  said  city.  His  injuries  consisted 
of  a  fracture  of  the  skull  and  left  knee  pan.  He  brought  suit 
and  on  the  trial  the  jury  in  their  verdict  awarded  him  among 
other  damages  $1,284  for  physical  and  mental  suffering.  The 
city  appealed  to  the  Supreme  Court,  and,  in  reversing  the 
judgment,  that  court  held  that  no  damages  can  be  recovered 
for  mental  suffering  except  where  it  is  the  natural  consequence 
of  the  physical  injury. 

Compression  of  the  Brain. — Compression  of  the  brain 
may  be  immediate  from  the  sudden  rupture  of  a  vessel, 
or  it  may  follow  concussion.  The  symptoms  are  progressive 
in  their  development,  increasing  as   the  hemorrhage  continues 


3l8  MEDICAL   JURISPRUDENCE. 

and  bear  a  relation  to  the  injury.  There  is  a  condition  of 
stupidity  which  deepens  into  coma,  paralysis  and  incontinence 
of  urine  and  feces.  The  pulse  is  hard  and  full,  the  pupils  are 
contracted  or  dilated  and  they  may  be  of  different  size.  Con- 
vulsions are  sometimes  found  as  a  symptom.  In  some  cases 
there  may  be  purulent  infiltration  and  the  formation  of  ab- 
scesses. 

When  the  skull  is  not  actually  fractured  but  when  the  soft 
parts  are  torn,  a  meningitis  may  arise  from  the  extension  of  an 
inflammation  with  purulent  formation.  Venous  thrombosis 
may  be  followed  by  extension  of  the  morbid  process.  If  there 
be  a  pouring  out  of  blood  between  the  internal  surface  of  the 
skull  and  the  dura  mater,  a  general  meningitis  is  apt  to  fol- 
low with  fatal  result. 

Contusio  Cerebri. — Actual  injury  to  the  brain  substance 
(contusio  cerebri)  may  occur  without  any  external  fracture,  but 
may  result  from  a  splintering  of  the  inner  table,  and  the  exter- 
nal violence  may  be  slight.  Wemay  have  transmitted  violence, 
most  likely  if  the  head  rests  on  a  hard  substance,  and  it  be 
struck  a  dull  and  heavy  blow  on  the  opposite  side.  In  such 
cases  we  have  a  conti-ecoiip,  which  results  in  basal  injury. 
Limited  injuries  are  apt  to  produce  convexity  troubles  and 
slight  meningeal  hemorrhages.  We  are  to  make  use  of  these 
distinctions  in  medico-legalcases,  for  early  symptoms  suggestive 
of  vertical  irritation  are  indicative  of  a  light  concentrated 
blow  ;  this  is  especially  the  case  if  there  is  a  limited  hemiplegia. 
In  basal  injuries,  from  presumably  heavy  blows,  we  find  pre- 
dominant symptoms  of  cranial  nerve  paralysis  and  disturbance 
of  the  medulla  oblongata. 

An  injury  upon  the  left  side  of  the  head  anteriorly  is  apt 
to  produce  aphasia. 

Blows  on  the  Side  of  the  Head  and  Deafness. — 

Blows  upon  the  side  of  the  head  occasionally  produce  deafness. 
Such  a  case  I  examined  a  few  months  ago.  The  man  had 
fallen  into  a  deep  hole,  striking  the  left  side  of  his  head.  He 
immediately  became  deaf,  and  a  few  months  later,  blind  in  the 
left  eye.  There  was  subsequently  a  decided  hemiparesis  of  the 
other  side  of  the  body. 

Convulsions  in  Paralyzed  Limhs. — Convulsions  in 
paralyzed  limbs  indicate  a  lesion  in  the  motor  centers  in  the 
frontal  and  parietal  lobes.  Especially  valuable  are  such  indi- 
cations when  new  parts  are  progressively  involved. 


CRANIAL   INJURIES.  319 

Latent  Disease  in  Cranial  Injuries. — The  mistake 
that  may  sometimes  be  made  of  overlooking  latent  disease 
is  a  very  grave  one.  Especially  is  this  the  case  where  the  sub- 
sequent death  of  the  individual  complicates  matters.  Abscess 
and  tumor  may  exist  for  a  long  time  without  giving  rise  to  any 
very  serious  manifestations  of  trouble.  A  light  headache,  slight 
mental  changes,  irritability  and  loss  of  memory  may  be  all  that 
we  find,  and  suddenly,  without  any  warning,  the  patient  may 
drop  dead  ;  and  upon  autopsical  examination  the  true  na- 
ture of  his  disease  becomes  apparent.  Not  only  in  the  matter 
of  feigning  do  we  consider  such  troubles,  but  in  their  connec- 
tion with  homicide.  Upon  many  occasions  persons  have 
been  arrested  and  convicted  for  ciusing  the  death  of  an- 
other, though  upon  inquiry  it  appears  that  the  injury  in- 
flicted was  insufficient  to  have  caused  the  death  of  the  sup- 
posed victim.  Numerous  examples  are  referred  to,  where  in  a 
brawl  or  in  a  simple  assault,  a  man  drops  dead  after  having 
been  lightly  pushed  or  struck.  It  then  becomes  our  duty  to 
determine  the  degree  of  responsibility  of  the  indicted  person, 
and  we  shall  seriously  neglect  our  duty  if  we  do  not  insist  upon 
a  post-mortem  examination  of  the  body  of  the  deceased.  We 
may  then  find  the  evidences  not  only  of  cerebral  disease,  but  of 
pulmonary,  cardiac,  and  vascular  troubles  as  well. 

Head  Injuries  in  Children. — Christison  refers  to  the 
interesting  case  of  a  woman  who  had  lost  several  children  within 
a  period  of  a  few  years,  and  no  reasonable  cause  could  be  as- 
signed for  their  deaths.  These  children  were  all  under  four- 
teen, and  their  demise  was  followed  by  a  sickness  attended  by 
headache,  vomiting  and  other  mischief.  A  medical  investiga- 
tion disclosed  the  fact  that  there  were  evidences  of  cerebral 
hypertrophy,  which  was  probably  the  cause  of  the  death  of  all 
the  children.  In  this  case  the  woman  was  arrested  upon  sus- 
picion. I  have  myself  known  of  examples  where  the  same  med- 
ico-legal point  might  have  arisen,  where  in  a  phthisical  family 
several  children  died  within  a  comparatively  short  time  of 
tubercular  meningitis  of  a  speedily  fatal  character,  and  where 
the  question  of  criminal  intent,  under  certain  circumstances, 
might  have  very  reasonably  arisen. 

Head  injuries  in  children  may  develop  in  scrofulous  subjects, 
a  condition  resembling  tubercular  meningitis,  but  we  must  be  on 
our  guard  in  such  cases  to  throw  out  the  possibility  of  the  dis- 
ease occurring  without  such  a  cause  ;  and  be  able  to  determine 
the  existence  of  hereditary  neurotic  taint.    Blows  and  falls  often 


530  MEDICAL  JURISPRUDENCE. 

precipitate  the  disease  in  the  children  of  tuberculous  parents. 
Blows  upon  the  back  of  the  head  are  especially  apt  to  produce 
tubercular  meningitis,  the  symptoms  of  which — sub-occipital 
headache,  hallucinations,  staggering  gait  with  a  tendency  to  fall 
backwards,  retraction  of  the  head,  ocular  symptoms,  delirium, 
comaj  and  death,  are  suggestive. 

Changes  in  the  display  of  mental  disturbances  occur  as  a  re- 
sult of  varying  pathological  processes.  An  exacerbation  of 
excitement  follows  a  temporary  vascular  change,  or  a  short  lived 
inflammatory  process. 

Complication  with  Other  Diseases. — Cranial  injuries 
have  been  reported  as  occurring  in  phthisical  patients  who 
have  died  from  the  original  disease  within  a  short  time  after  the 
injury,  and  in  one  case  the  man  was  beaten  about  the  head 
and  chest,  and  there  was  slight  hemorrhage  at  the  time.  He 
died  ten  months  after  the  blow  upon  the  head. 

A  most  recent  case,  which  illustrates  the  possibility  that 
cerebellar  symptoms  following  a  bloWmay  be  due  to  some  pre- 
existing disease,  which  perhaps  the  violence  has  developed,  is 
that  reported  by  Dr.  Fraser.* 

The  patient  was  a  man  who  had  received  a  fracture  of  the 
parietal  bone  by  a  brick  that  had  fallen  from  a  great  height. 
He  was  at  first  insensible,  but  was  able  in  the  course  of  three 
weeks  to  return  to  his  work.  He  suffered,  however,  from  occi- 
pital headache  of  a  severe  character,  and  during  the  next 
fifteen  months  was  deaf,  and  with  this  there  was  some  ambly- 
opia and  a  variety  of  symptoms  suggestive  of  mental  enfee- 
blement.  He  was  stupid,  of  slow  thought,  and  greatly  depressed. 
A  few  months  later  his  gait  became  ataxic,  he  had  an  inclina- 
tion to  fall  backwards,  and  he  presented  the  "circus  move- 
ments "  described  by  some  authors  as  suggestive  of  cerebellar 
disease.  In  addition,  there  was  double  optic  neuritis,  with 
vertigo  and  vomiting,  and  difficulties  in  co-ordination.  Subse- 
quent examination  revealed  the  existence  of  well  marked 
syphilitic  indications,  such  as  nodes,  eruptions,  and  cicatrices, 
and  it  was  determined  to  try  the  effect  of  specific  treatment. 
Under  the  use  of  large  doses  of  iodide  of  potassium  his  troii- 
bles  diminished  in  severity,  and  he  rapidly  revovered.  In  this 
case  it  is  very  probable  that  the  blow  was  an  exciting  cause  of 
cerebral  syphilis.  Althougli  the  situation  is  not  favorable  for  a 
contrecoup  that  would  give  rise  to  cerebral  disease,  it  is  possi- 

*  London  Lancet,  M.^y  I2,  1883. 


CRANIAL   INJURIES.  32  t 

ble  that  a  diffused  meningeal  inflammation  and  deposit  of 
gummatous  matter  took  place  as  an  extending  lesion,  and  had 
the  case  given  rise  to  medico- legal  complications  the  question 
of  limited  criminality  might  justly  have  been  urged. 

Otitis  in  Cranial  Injuries. — In  certain  cases  of  aural 
disease  a  slight  injury  may  precipitate  death.  Cases  of  otitis 
media  have  been  reported  in  which  the  aural  discharge  had 
ceased  after  the  person  had  either  been  struck  with  the  fist  or 
had  received  some  equally  trivial  injury.  In  one  such  case  a 
patient  died  comatose  within  one  month  after  an  injury  and  a 
cranial  abscess  was  found  which  undoubtedly  resulted  from  the 
disease  of  the  ear.  In  this  case  the  patient  was  struck  in  the 
chest  and,  in  attempting  to  resent  the  injury,  hit  his  head 
against  a  door. 

Brain  Abscesses. — The  tendency  of  severe  brain  injuries 
may  be  to  the  formation  of  an  abscess,  which  may  burst  in- 
to the  ventricles,  and  be  discharged  through  the  ear,  as  occur- 
red in  Mr.  Hawkins'  case,  where  there  was  a  copious  discharge 
a  few  weeks  after  a  head  injury.  Many  injuries  giving  rise  to 
head  symptoms  are  quite  likely  to  cause  a  variety  of  inflamma- 
tory action,  in  which  there  is  extensive  accumulation  of  serum, 
which  distends  the  ventricles  and  infiltrates  all  the  cranial  tis- 
sues. Abercrombie  reports  cases,  which  show  that  the  symp- 
toms appear  gradually  with  a  slow  formation  of  effusion,  but 
that  sometimes  the  latter  may  be  very  rapid  and  the  symptoms 
correspondingly  prompt  in  their  expression. 

Alcoholism  in  Cranial  Injuries. — The  patient's  previous 
habits  may  aggravate  an  injury  which  in  a  healthy  man  would 
produce  little  or  no  mischief.  Cases  are  reported  where  in  a 
drunken  state  a  person  has  received  a  slight  head  injury  which 
was  followed  by  death  and  yet  no  cerebral  lesions  directly  due  to 
the  wound  were  found.  Sir  Charles  Bell  reports  such  a  case,  the 
victim  being  a  woman  of  bad  habits  who  while  being  remonstrated 
with  by  her  husband,  a  good-tempered,  industrious  man,  suddenly 
died  from  a  cerebral  hemorrhage.  The  husband  struck  her  in  the 
struggle,  but  not  a  blow  of  any  force,  and  after  death  no  scar  or 
superficial  extravasation  was  found.  Bell  testified  that  the  con- 
dition of  intoxication  and  the  general  diseased  state  of  the  vessels 
predisposed  to  the  rupture,  and  that  the  blow  was  the  exciting 
cause.     The  prisoner  was  acquitted. 

Beck  in  commenting  upon  the  above  case,  says  :  "  It  may, 


32  2  MEDICAL   JURISPRUDENCE. 

however,  be  urged  that  the  tendency  of  the  remarks  in  the  text 
is  to  exonerate  all  and  every  one  from  the  consequences  of  in- 
juries inflicted  on  the  intemperate.  Not  so,  if  these  injuries  are 
recent,  and  if  they  cannot  be  confounded  with  the  effects  of 
natural  disease,  they  are  to  be  estimated  like  all  other  wounds. 
Severe  blows,  followed  rapidly  by  convulsions,  coma  and  death, 
and  exhibiting  on  dissection  effusion  af  blood  upon  the  brain 
without  any  other  disease  of  that  part,  present  a  very  conclusive 
case  of  the  effects  of  violence." 

It  may  sometimes  be  necessary  to  distinguish  the  state  of  un- 
consciousness that  results  from  concussion  and  drunkenness. 
This  is  sometimes  an  extremely  difficult  matter,  for  alcoholism 
as  well  as  concussion  may  be  followed  by  secondary  results. 
Great  care  should  be  taken  to  investigate  the  patient's  behavior 
and  condition  previous  to  the  supposed  accident,  the  presence 
of  tlie  fumes  of  alcohol  and  the  manner  of  the  injury.  If  death 
has  taken  place,  alcohol  may  be  found  in  the  stomach.  In 
some  cases  it  maybe  well  to  examine  the  urine  by  the  bichro- 
mate of  potassium  test,  and  if  death  has  ensued,  we  may  look  for 
the  appearance  of  renal  and  hepatic  degeneration  as  well  as  for 
diseased  cerebral  vessels  and  meninges. 

When  the  patient  has  received  an  injury  when  intoxicated 
the  question  may  be  extremely  difficult  to  decide. 

The  Coil) plication  of  Erysipelas. — The  complication  of 
erysipelas  is  one  that  is  of  some  interest  when  it  occurs  in  per- 
sons who  have  received  head  injuries.  In  one  such  case,  that  of 
a  woman  who  had  been  struck  with  a  smoothing  iron  and  who 
afterwards  disregarded  her  injury  and  drank  to  excess,  a  fatal 
attack  of  erysipelas  occurred.  It  was  shown  that  the  wound 
which  simply  involved  the  scalp  at  first,  had  taken  on  a  violent 
inflammatory  action  which  resulted  in  perforation  ;  that  she 
was  able  to  go  about  for  over  a  month,  attending  balls  and  in- 
dulging in  her  trade — that  of  a  prostitute — and  that  her  erysi- 
pelas and  not  her  wound  was  the  cause  of  her  death.  It  was 
further  sliown  that  at  the  time  there  was  an  epidemic  of  erysi- 
pelas in  Edinburgh.  The  prisoner  was  found  guilty  simi)l}'  of 
assault. 

•  *  Dr.  Dunlop,  who  reported  the  case,  calls  attention  to  the 
fact  that  no  evidence  to  prove  the  exact  date  of  the  commence- 
ment of  the  erysipelas  was  to  be  had.       It  was  unfortunate,  for 

*  Edinbu7-g  Med.  and  8nrg.  Journal,  vol.  21,  p.  488,  and  Beck's  Medi- 
cal lurisprudence,  vol.  2,  p.  305. 


CRANIAL   INJURIES.  323 

it  might  have  shown  whether  the  erysipelas  began  in  the  wound 
as  it  always  does  in  the  traumatic  variety,  or  elsewhere,  as  is 
usually  the  case  in  the  idiopathic  form. 

Trivial  Blows  and  their  Occasional  Results. — Cases 
are  reported  where  a  very  trivial  injury  has  given  rise  to  grave 
head  symptoms.  Falls  from  inconsiderable  heights,  from  a 
chair  or  some  slight  elevation,  have  resulted  in  fracture  of  the 
base  of  the  skull.  Casper  speaks  of  a  woman  who  fell  in  a  cup- 
board and  a  fracture  of  the  petrous  portion  of  the  right  temp- 
oral bone  was  the  result.  In  old  persons  such  accidents  are  by 
no  means  uncommon  and  care  should  be  taken  in  medico-legal 
cases  not  to  confuse  them  with  cerebral  hemorrhage  or  other 
conditions. 

Unconsciousness  without  Apparent  Marks. — It  occa- 
sionally happens  that  a  person  is  found  unconscious  after  an  as- 
sault and  no  external  mark  of  injury  is  discovered.  The  patient 
may  subsequently  die  and  post-mortem  examination  reveals  a 
fracture  of  the  skull  with  extravasation.  It  is  highly  probable  in 
such  cases  that  what  is  known  as  a  sandclub  is  used — a  bag  made 
of  some  cloth  or  cotton  stuff  and  filled  with  sand.  This  sus- 
picion is  increased  by  the  presence  of  ecchymosis  beneath  the 
site  of  the  blow  and  fracture  at  the  base,  for  the  violence  is 
transmitted  in  most  cases  by  contrecoup. 

As  an  illustration  of  how  trivial  head  injuries  may  sometimes 
have  a  fatal  termination,  I  may  refer  to  the  case  reported  by 
Mr.  Ashmun,*  in  which  a  small  stone  wns  thrown,  striking  a 
man  upon  the  side  of  his  liead  and  causing  death  in  ten  minutes. 
"  There  was  no  external  bruise  and  no  fracture.  The  cranium 
was  found  to  be  extremely  thin,  and  the  ventricles  were  filled 
with  coagulated  blood,  and  the  pia  mater  and  vessels  of  the 
brain  were  gorged  with  blood."  The  dura  was  healthy.  The 
verdict  was  manslaughter,  which  Ashmun  thought  was  too 
severe. 

I  may  refer  in  this  connection  to  a  case  reported  by  O'Hal- 
loran,  of  a  man  who  received  a  blow  upon  the  head  with  a 
cudgel,  which  left  some  headache  and  fullness,  but  there  was 
nothing  else  for  many  months,  when  an  elevation  appeared  at 
the  seat  of  the  injury,  of  considerable  size,  and  when  this  was 
opened  there  was  found  beneath  an  aperture  in  the  cranium  the 
size  of  a  half  crown,  and  beneath,  the  dura  mater  was  found 
covered  with  pus,  and  this  part  subsequently  became  the  seat  of 

*  American  Jurist,  vol.  15,  p.  108. 


324  MEDICAL  JURISPRUDENCE. 

a  fungous  growth.  Numerous  cases  of  this  kind  are  detailed  by 
Abernethy,  Norris  and  others,  in  which  a  serious  injury  was 
masked  by  a  premature  closure  of  the  wound,  and  the  real 
condition  of  affairs  was  not  discovered  until  later., 

Howship  refers  to  the  case  of  a  boy  who  received  a  blow 
on  the  head  with  a  ruler,  which  was  followed  by  a  small  dis- 
charging sore  that  healed  at  the  end  of  six  years.  Then 
the  boy's  sight  was  impaired  and  he  manifested  epilepsy. 
After  his  death,  which  resulted  from  trephining,  evidences  of 
chronic  inflammation  of  the  brain  and  its  membranes  were 
discovered  beneath  the  point  of  injury.  Abernethy,  in  re- 
ferring to  these  cases,  states  that  very  often  the  disease  is 
confined  to  the  inner  table  and  extends  inwards,  producing 
cerebral  disease. 

Taylor  relates  some  cases  where  boys  who  had  had  their 
ears  boxed,  and  where  no  undue  violence  had  been  used,  died 
shortly  afterwards.  The  case  of  "  Regina  vs.  Hopley "  is 
one  of  these.  The  boy's  stupidity,  which  was  the  result  of  dis- 
ease, affected  intellectual  development.  He  presented  no  un- 
usual symptoms  of  critical  disease  up  to  the  time  the  flogging 
was  administered,  but  three  years  after  the  punishment  he 
died.  Taylor  also  refers  to  the  case  of  a  boy  who  received  two 
slight  blows  on  the  face.  He  went  to  his  work  the  next  day, 
but  complained  of  pain  in  his  head,  which  increased  so  that  two 
days  afterwards  he  was  obliged  to  give  up  everything  and  take 
to  his  bed.  His  condition  became  worse  and  death  followed  in 
fourteen  days.  At  the  post  mortem  the  only  morbid  appear- 
ance found  was  a  small  tumor  in  the  dura  mater  over  the  post- 
erior face  of  the  petrous  portion  of  the  right  temporal  bone. 
It  was  held  by  those  who  made  the  examination,  that  the  boy's 
death  had  not  resulted  from  the  violence,  that  the  tumor  was  of 
long  growth  ;  and  that  some  time  before  the  injury  he  had  com- 
plained of  pain  in  his  head,  and  that  the  slight  violence  could 
hardly  have  affected  this  deep-seated  lesion. 

A  case  may  be  cited  of  a  man  who  was  struck  upon  the 
face  with  the  palm  of  the  hand  without  the  production  of  local 
effects.  Within  a  few  days  he  complained  of  very  severe  pain 
in  his  head  nnd  at  the  end  of  the  thirteenth  day  he  sought  medi- 
cal aid.  The  following  day  he  became  much  worse  and  died 
rather  suddenly.  No  signs  that  could  be  traced  to  the  accident 
were  found  at  the  autopsy,  but  attached  to  the  petrous  portion 
of  the  temporal  bone  was  found  a  small  tumor  the  size  of  a 
hazelnut.  It  afterwards  transpired  that  the  man  had  com- 
plained of  pain  for  over  a  year* 


CRANIAL    INJURIES.  325 

Head  Injury  as  the  Result  of  a  Fall  upon  the 
Feet. — In  very  rare  cases  a  fall  upon  the  feet  has  been  known 
to  produce  a  fracture  at  the  base,  and  this  was  the  cause  of  the 
death  of  the  Duke  of  Orleans. 

Blows  with  the  Fist. — Blows  with  the  fist  produce  ecchy- 
mosis,  wounds  if  produced  are  small  and  rarely  divide  the  skin 
in  a  clean  cut  manner  and  are  not  usually  followed  by  very 
grave  cerebral  conditions,  excepting,  perhaps,  when  the  blow 
is  inflicted  behind  the  ear. 

Considerable  care  must  be  exercised  in  examining  the  heads 
of  persons  who  have  received  blows,  and  the  appearance  of 
the  swelling  and  ecchymosis  must  be  closely  investigated. 
Collections  of  blood  beneath  the  scalp  are  always  taken  for 
graver  injuries,  and  there  may  be  a  depression  in  the  center, 
which  in  many  instances  has  deceived  the  physician  who  imag- 
ined it  to  be  a  fracture  of  the  skull.  Harrison  cautions  the 
observer  against  mistaking  the  throbbing  of  the  lump,  which  may 
be  after  all  transmitted,  for  that  of  the  pulsation  of  the  brain, 
which  does  not  exist.  These  points  are  important  to  remember 
in  courts  of  law,  where  the  testimony  of  a  medical  witness  is  to 
the  effect  that  there  was  a  fracture  of  the  skull,  and  his  evi- 
dence, which  is  perhaps  the  result  of  an  erroneous  conclusion, 
should  be  carefully  sifted.  There  are  numerous  cases  of  death 
from  concussion,  where  there  is  neither  fracture  of  the  skull, 
effusion  of  blood,  nor  any  observable  injury.  A  number  of  these 
cases  are  reported  by  the  older  writers,  where  a  blow  by  the  fist 
has  been  the  cause  of  almost  immediate  death,  where  there 
has  been  nothing  to  account  for  the  same,  except  the  violence 
itself.  Case  of  this  kind  is  reported  by  Harrison.  "  George 
Macclish  and  John  Macvey  were  tried  in  Glasgow,  on  the  29th 
of  December,  1831,  for  the  assault  and  murder  of  William  Car- 
lyle,  on  the  September  preceding.  Carlyle  and  a  friend,  while 
on  their  way  home  late  at  night,  were  met  by  seven  or  eight 
men  standing  at  the  corner  of  a  street  who  accosted  them. 
A  quarrel  was  the  result,  when  Macclish  struck  Green,  the 
friend  of  Carlyle,  knocking  him  down,  when  he  arose  and  was 
again  knocked  down  by  Macvey.  When  he  recovered  he  looked 
about  for  Carlyle,  who  also  had  been  knocked  down  by  Mac- 
clish, and  he  was  found  dead.  Carlyle's  head  contained  a  con- 
siderable effusion  of  blood  beneath  the  skull,  with  extravasa- 
tion of  blood  on  the  brain.  In  this  case  the  medical  witnesses 
were  unable  to  agree  whether  the  blows  or  falls  were  the  cause 
of  death,  and  there   being   no    proof   of   malice  the  prisoners 


326  MEDICAL   JURISPRUDENCE. 

were  acquitted  of  murder,  but  were  found  guilty  of  culpable 
homicide  and  were  sentenced  to  fourteen  years'  imprisonment. 
Numerous  cases  of  death  of  this  kind,  the  subjects  being  prize 
fighters,  have  from  time  to  time  been  brought  forward,  and  in 
many  instances  death  had  followed  blows  upon  the  ear  and  at 
the  back  part  of  the  head.  In  fact  it  may  be  said  that  in  these 
instances  an  inconsiderable  amount  of  violence  is  likely  to  be 
followed  by  a  fatal  result. 

Rare  cases  have  been  reported,  in  which  there  has  been 
atrophy  and  absorption  of  bone,  without  any  destruction  of 
the  integuments,  as  the  result  of  a  fall.  Such  a  case  is  detailed 
by  Howship,  in  which  the  right  parietal  bone  was  injured,  but 
there  was  no  external  wound.  Some  weeks  subsequently,  how- 
ever, the  pulsation  of  the  brain  could  be  perceived  at  the  point 
of  injury,  and  the  child  became  paralytic. 

Prognosis  of  Cranial  Injuries.— The  prognosis  of  cra- 
nial injuries  is  very  uncertain  ;  forms  in  which  fracture  is  pro- 
duced are  extremely  unfavorable,  and  the  presence  of 
symptoms  of  meningitis,  or  purulent  encephalitis  are  equally 
bad.  The  duration  of  the  primary  unconsciousness  has 
much  to  do  with  the  subsequent  improvement  or  the  re- 
verse, and  the  symptoms  of  compression  are  especially  of  serious 
import.  The  nature  of  blow  should  be  taken  into  account — 
whether  it  is  made  by  a  dull  heavy  instrument  or  by  one 
with  a  sharp-cutting  edge — and  in  the  latter  case  if  there  is  no 
fracture  the  patient's  chances  are  better.  Blows  upon  the  ver- 
tex or  over  the  ear  are  bad  and  in  the  latter  case  an  otitis  with 
subsequent  cerebral  symptoms  may  follow. 

Patients  may  receive  comparatively  serious  accidents  and  yet 
be  immediately  able  to  seek  assistance.  A  case  is  mentioned  of  a 
laborer  who  was  struck  upon  the  head  with  a  pick-ax,  the  point 
entering  the  brain  to  the  depth  of  the  left  lateral  ventricle, — yet 
he  walked  a  mile  and  a  half  to  the  hospital. 

We  cannot  always  say  that  such  and  such  an  injury  is 
necessarily  fatal,  for  there  are  important  exceptional  cases 
where  extensive  destruction  of  tissue  has  taken  place  without 
apjjarently  shortening  the  life  of  the  individual,  and  there  are 
numerous  cases  where  bullets  and  other  missiles  have  become 
encysted.  I  know  of  a  dislinguislied  judge  who  carries  in 
his  brain  to  this  day,  a  bullet  which  i)enetrated  the  cranium 
during  the  civil  war,  and  *Elliot  reports  the  case  where  a  bul- 
let remained  in  the  brain  for  sixty-five  years  !      The  patient  in 

*  JLdinbur^  Med.  and  Surgical  Journal,  Pec.  j88o. 


CRANIAL   INJURIES.  327 

this  case  was  a  man  who  was  shot  in  the  eye,  the  bullet  lodging 
probably  in  the  occipital  lobe. 

In  some  of  these  cases  in  which  the  patient  temporarily  sur- 
vives the  accident,  the  prisoner  may  be  convicted  simply  of 
assault,  and  when  death  does  occur,  it  is  often  supposed  to  be 
from  other  causes. 

Contusions  and  their  Results. — The  consequences  of 

contusions  of  the  scalp  have  been  sometimes  severe,  and,  as 
I  have  mentioned,  not  only  may  epilepsy  follow  such  injuries, 
but  we  often  find  cases  of  trigeminal  neuralgia  of  an  extraor- 
dinarily severe  character  arising  subsequent  to  a  blow  upon  the 
head  and  superficial  wounding.  It  has  been  shown  by  the  statis- 
tics in  the  Medical  and  Surgical  History  of  the  War  of  the  Rebel- 
lion, that  contusions  of  the  scalp  as  produced  by  projectiles  are 
quite  likely  to  be  followed  by  the  most  serious  consequences 
and  severe  intra-cranial  trouble.  When  the  cranial  bones  are 
subjected  to  violence,  we  may  find  that  a  slight  blow,  not  suf- 
ficient to  cause  fracture,  may  sometimes  give  rise  to  such  injury 
that  necrosis  of  the  part  follows,  and  exfoliation  and  discharge 
of  bones  takes  place  after  some  time.  Of  course  the  force 
exhibited  may  produce  death  of  the  external  table  of  the  skull 
alone,  or  of  the  internal  as  well.  The  local  pain  that  some- 
times exists  for  a  long  time  after  an  injury  need  not  be  men- 
ingeal in  character,  but  may  symptomatize  an  inflammation  of 
the  cranial  bones  which  are  beneath  the  seat  of  contusion. 
We  find  in  such  cases  that  there  is  usually  some  thickness  or 
hypertrophy  beneath  the  cicatrix,  and  that  slight  pressure  may 
cause  a  great  deal  of  suffering.  Under  certain  circumstances 
we  find  that  the  diploe  may  be  the  seat  of  inflammation  as  the 
result  of  head  injury  ;  in  such  cases  the  symptoms  are  insidi- 
ous in  their  development,  and  we  are  apt  to  find  meningitis 
and  serious  trouble. 

The  Prognosis  of  Traumatic  Inflammation. — In- 
juries followed  by  inflammation  of  the  brain  give  rise  to  pro- 
nounced symptoms  which  rarely  appear  before  a  week  at  least. 
Yet  if  there  is  a  conspicuous  rise  of  temperature  serious  mis- 
chief may  be  expected,  it  is  therefore  safe  for  the  medical  man 
to  be  exceedingly  careful  lest  he  may  say  that  because  the  blow 
is  not  immediately  followed  by  bad  symptoms,  that  the  injury 
is  not  a  serious  one,  or  that  the  secondary  condition  is  purely 
the  result  of  the  patient's  carelessness,  or  that  it  is  due  to  an- 
other cause. 


328  MEDICAL   JURISPRUDENCE. 

In  advanced  cases  we  are  are  to  give  a  very  guarded  prog- 
nosis, but  there  are  cases  in  which  there  can  be  little  doubt  as 
to  the  progress  and  termination  of  the  symptoms.  When,  for 
instance,  there  is  a  well-developed  series  of  progressive  symp- 
toms indicative  of  structural  degeneration,  consisting,  perhaps, 
of  paralysis  with  contractions  and  increased  tendinous  reflexes, 
optic  neuritis  with  choked  disc,  convulsions,  tremor  increased 
with  voluntary  effort,  mental  impairment  with  loss  of  memory, 
the  case  is  likely  to  terminate  fatally  in  a  comparatively  short 
time. 

An  interesting  point  is  the  possible  distinction  between  trau- 
matic inflammation  of  different  kinds.  Holmes  considers  this 
matter  very  fully,  and  does  not  believe  that,  for  instance,  in  the 
one  case  it  can  be  said  that  the  brain  is  alone  affected,  and  in 
another  that  the  membranes  are.  We  are  to  be  guided  largely 
by  the  time  of  appearance  of  such  symptoms  as  evidence  of 
the  injury.  Holmes  points  out  that  inflammatory  symptoms 
are  apt  to  be  of  very  early  development  after  fracture,  within  a 
few  hours  or  a  few  days ;  while  with  contusion  several  days 
are  apt  to  elapse  before  the  inflammatory  symptoms  make 
their  appearance ;  and  in  cases  of  another  kind,  where  there 
has  been  trouble,  it  may  often  be  several  weeks  after  the 
subsidence  of  light  symptoms  before  the  expressions  of  grave 
cranial  trouble  are  presented.  So  far  for  the  probable  kind 
of  injury. 

As  to  localization  the  matter  is  perhaps  more  difficult.  For 
we  have  to  deal  with  pathological  processes,  which  are  often 
extensive  and  advancing. 

Head  Injuries  and  Pyemia. — Head  injury  may  be  fol- 
lowed by  pyemia,  and  this  is  the  case  more  often  in  slight  trau- 
matisms where  perhaps  the  only  trouble  may  be  a  scalp  wound 
or  contusion.  In  328  cases  reported  in  the  "  Medical  and  Surgical 
History  of  the  Rebellion  "  of  contusions  as  the  result  of  gun- 
shot, the  head  being  the  seat  of  injury,  but  one  case  of  pyemia 
was  reported,  which  shows  the  complication  is  not  so  frequent 
a  one  as  where  other  parts  of  the  body  are  wounded.  The  loca- 
tion of  extravasations  of  blood  in  the  cranial  cavity,  but  more 
often  beneath  the  arachnoid,  vary  greatly.  The  symptoms  are 
usually  those  of  comjjression,  and  if  the  collections  be  not 
too  great  we  may  find,  as  the  brain  accommodates  itself 
to  pressure,  that  there  is  a  remission.  Sometimes  this 
lightening  up  of  the  trouble  may  follow  the  use  of  the 
trephine  ;  or,  as  in  the  case  reported  by  Holmes,  the  escape  of 


CRANIAL    INJUIIES.  329 

blood  from  a  vessel  in  the  neighborhood.  "In  the  year  1859 
a  man  was  struck  with  a  spade,  just  over  the  anterior  inferior 
angle  of  the  right  parietal  ;  and  when  he  came  to  St.  George's 
Hospital  a  few  minutes  afterwards,  a  compound  fracture,  with 
depression  of  a  small  piece  of  the  skull,  was  detected.  But 
there  was  no  cerebral  symptom  whatsoever.  Shortly  after- 
wards, however,  the  patient  became  heav^y  and  stupid  ;  and 
coma  was  gradually  supervening,  when  Mr.  Kidd  arrived,  and 
at  once  proceeded  to  remove  the  depressed  bone,  whereupon  a 
jet  of  blood  spurted  out  from  a  large  branch  of  the  meningeal 
artery,  and  all  the  symptoms  of  compression  were  immediately 
relieved." 

The  Nature  of  Extravasations. — The  nature  of  the 
collection  of  effused  blood  which  is  found  extravasated  in  the 
cranial  cavity  is  to  be  determined  with  regard  to  the  time  of  the 
injury.  Blood  when  recently  poured  out  is  bright  and  clotted, 
and  at  a  later  stage  is  darker  and  more  firm,  after  two  weeks  it 
becomes  yellow,  and  later  on  a  well  organized  fibrinous  mass 
remains. 

Influence  of  Head  Injuries  upon  Previously  Exist- 
ing Mental  Disease. — It  not  infrequently  happens  that  a 
blow  upon  the  head  will  in  individuals  of  weak  mind,  or  in 
those  who  have  suffered  for  years  from  some  form  of  disease, 
produce  a  sudden  improvement  or  restoration. 

Sir  Astley  Cooper  tells  of  a  sailor  who  remained  in  a  stupid 
state  after  a  cranial  injury  for  fully  a  year,  and  was  then  suddenly 
restored  by  the  operation  of  trephining.  Cases  of  this  kind 
have  a  dramatic  significance  which  has  led  novelists  and  play- 
wrights to  make  use  of  them.  The  books  contain  instances  of 
persons  suddenly  deprived  of  consciousness  in  the  midst  of 
a  pursuit,  and  some  time  after  taking  up  the  thread  of  thought 
after  sudden  restoration. 

Abercrombie  tells  of  a  lady  who  had  an  apoplectic  attack  in 
the  midst  of  a  game  of  cards.  The  first  words  she  uttered  after 
she  recovered  her  consciousness  some  days  later  were  "  What 
is  trumps  ?  " 

In  such  cases  there  is  a  prolonged  compression  of  the  brain 
and  in  medico-legal  cases  the  question  of  curability  arises — 
whether  or  not  proper  surgical  treatment  might  effect  a  cure. 
Pritchard  relates  the  case  of  three  idiot  brothers.  One 
received  a  blow  upon  the  head  and  afterwards  seemed  to  un- 
dergo a  very  decided  change  for  the  better  in  his  mental 
condition,   and   ultimately  became   a   clever   barrister,    while 


33©  MEDICAL   JURISPRUDENCE. 

his  brothers  remained  imbecile.  Cases  of  insanity  have  been 
caused  by  blows  upon  the  head,  and  the  same  thing  is  true 
with  epilepsy. 

Affections  of  Speech  as  the  Result  of  Head  In- 
juries.— Affections  of  speech  as  a  result  of  head  injuries  are 
conmion  enough.  Dr.  Hoy,*  of  Racine,  Wisconsin,  reports 
three  interesting  cases,  in  the  first  of  which  a  fracture  of  the 
skull  occupying  the  anterior  superior  angle  of  the  left  parietal 
bone  existed.  The  immediate  insensibility  disappeared  after 
the  use  of  the  trephine,  but  returned  a  few  days  afterwards  and 
was  due  undoubtedly  to  the  pressure  of  retained  blood,  and 
this  was  verified  by  the  removal  of  the  stitches,  when  the 
patient's  mind  again  became  clear.  The  doctor  found  that  by 
making  pressure  with  his  thumb  over  the  opening  he  could  at 
will  temporarily  suspend  the  faculty  of  speech. 

The  third  case  was  that  "of  a  man  living  in  Vermont  who  was 
standing  near  his  mill  bantering  with  his  son  about  shooting  a 
kingfisher  that  was  perched  on  a  dry  snag  that  was  projected 
from  the  water  in  the  pond.  The  son  fired,  and  the  rifle-ball, 
a  small  one,  missed  the  bird,  ricochetted  and  struck  the  father 
near  the  middle  of  the  forehead.  He  dropped  instantly,  and 
for  a  long  time  it  was  thought  impossible  for  him  to  recover  ; 
but  time  wore  on,  and  he  still  lived,  a  mere  animal,  incapable 
of  speech,  for  fifteen  years,  at  which  time  there  appeared  a 
slight  elevation  of  the  skull  at  the  crown  of  the  head.  Dr. 
Mussy  was  called  and  trephined  the  spot,  when  he  was  enabled 
to  remove  the  flattened  ball  that  had  remained  so  long  within 
the  skull  In  a  few  minutes  the  old  man  called  out,  "  Zeke, 
you  dog,  you  missed  it  !  "  "  Missed  what  ?"  asked  the  doctor. 
"  Why,  the  kingfisher  !  "  This  was  the  first  word  spoken  since 
the  accident,  and  he  could  not  understand  that  the  report  of 
the  rifle  was  not  still  reverberating  over  the  water  at  that  mo- 
ment. Zeke  was  married,  had  a  family  and  was  living  in  the 
West.  The  father  had  grown  gray,  and  all  was  changed.  A 
Rip  Van  Winkle  in  reality." 

Insanity  during  litigation. — It  occasionally  happens 
that  the  plaintiff  in  a  suit  for  damages  for  physical  injury  may 
subsequently  become  insane.  Such  a  case  (Martin  vs.  Penn. 
R.  R.  Co.)  in  which  I  appeared  as  medical  witness,  was  tried 
a  few  months  ago. — 

The  plaintiff  was  injured  in  a  collision  between  two  steam- 

*  Journal  oj  Menial  and  N^ervoiis  Dijcascs,  New  Series,  vol.  ii.,  p.  2. 


CRANIAL  INJURIES.  33 1 

boats  and  was  wedged  between  the  seats  in  the  cabin  of  the 
ferry  boat  in  which  he  was  at  the  time.  His  momentary  inju- 
ries Avere  seemingly  trivial  the  most  severe  of  which  was  a  blow 
upon  the  head,  but  his  sufferings  later  were  very  great.  A  few 
months  after  the  accident  he  became  morose,  nervous,  indiffer- 
ent, and  violent  towards  his  family,  and  finally  it  was  found 
necessary  to  confine  him  in  an  asylum  for  the  insane.  In  the 
meantime  his  suit  was  tried  and  he  was  brought  into  court. 
His  behavior  upon  the  witness  stand  and  during  his  private 
examination  was  strikingly  suggestive.  He  claimed  that  the 
motions  of  his  counsel  were  improper  and  that  he  did  not  need 
damages.  He  also  had  the  most  magnificent  schemes  and 
ideas  of  his  wealth  and  the  delusion  that  he  was  in  personal 
communication  with  God.  In  this  case  the  question  arose, 
whether  an  insane  man  was  competent  to  bring  a  suit.  The  ap- 
peal was  decided  in  his  favor  and  the  matter  was  compromised. 


Case  LVI, — Railway  injury. — Release  of  defendants 
disputed  on  ground  of  insanity  of  plaintiff. con- 
tract declared  valid,  plaintiff  being  considered 
responsible  at  time  it  was  made. 

George  ) 

vs.  >•  34  Arkansas  Reports  613. 

St.  L.  M.  &  S.  Ry  Co., ) 

On  Nov.  17,  1876  plaintiff  while  riding  as  a  regular  passen- 
ger on  a  train  of  the  defendants,  traveling  from  Little  Rock  to 
Texarkana  was  injured  severely  on  the  head  in  an  accident  to 
said  train,  which  injury  caused  him  great  pain.  On  Nov.  29, 
1876,  while  still  suffering  from  said  injury,  he,  in  consideration 
of  the  sum  of  $100  signed  a  release  to  the  defendant  company 
for  all  damages  caused  by  said  injury,  but  when  he  recovered 
from  the  effects  of  the  injury  and  was  informed  by  his  wife 
that  he  had  signed  a  receipt  he  had  no  recollection  of  it  and 
went  to  the  agent  of  the  company  to  see  the  receipt,  but  his 
request  was  refused.  He  made  no  offer  to  return  the  $100 
but  claimed  that  he  never  received  it,  that  he  had  no  recollec- 
tion of  signing  the  release.  On  the  trial  the  attending  physician 
testified  that  his  injury  consisted  of  a  severe  scalp  wound  ;  that 
his  mind  was  clear  on  Nov.  29  ;  and  witnesses  of  the  transac- 
tion testified,  that,  though  plaintiff  was  confined  to  his  bed 
when  he  signed  the  release  he  seemed  to  know  what  he  was  doing, 


332  MEDICAL   JURISPRUDENCE. 

that  he  appeared  to  be  perfectly  sane  ;  that  there  were  several 
members  of  his  family  present ;  that  an  offer  of  $60  was  made  to 
him,  but  he  refused  to  take  less  than  $100.  On  the  other  hand 
the  keeper  of  the  hotel  to  which  plaintiff  was  brought  after  the 
accident  testified  that  plaintiff  was  confined  to  liis  room  until 
January  6,  1877  ;  that  he  saw  plaintiff  daily  until  December  6, 
1876  ;  that  sometimes  he  seemed  rational  and  sometimes  he 
talked  at  random  and  flighty.  Under  a  charge  that  it  was 
plaintiff's  duty  to  offer  to  return  the  money  if  he  wished  to  re- 
pudiate the  contract  the  jury  found  for  defendant. 

On  appeal  to  the  Supreme  Court  the  judgment  was  reversed 
and  the  case  remanded  for  trial  on  the  ground  that  if  plaintiff 
was  insane  when  he  signed  the  release,  it  was  a  question  for  the 
jury  whether  he  was  in  ignorance  of  the  existence  of  the  release 
when  he  brought  suit, 

Watson*  says: — "In  criminal  trials  for  the  infliction  of  in- 
juries upon  the  head,  in  which  the  injured  individual  is  able  to 
be  a  witness,  it  is  obvious  from  the  disordered  state  of  the  intel- 
lectual faculties,  and  particularly  of  memory,  arising  from  con- 
cussion, that  his  evidence  should  be  taken  with  extreme 
caution  in  regard  to  circumstances  which  happened  at  the  time 
of  the  injury  and  indeed  it  should  only  be  received  in  so  far 
as  it  is  coroborated  by  other  testimony." 

Post-Mortem  Deteriiunation  of  Suicide  or  Homi- 
cide.— It  is  a  matter  of  imi)ortance  to  dettrmine  whether  the 
fractures  of  the  skull  which  are  found  are  the  result  of  violence 
inflicted  during  life  or  afterwards  ;  and  very  often  this  is  an  im- 
portant element  in  fixing  the  guilt  or  innocence  of  the  suspected 
person.  Casper,  who  has  conducted  a  number  of  experiments 
on  dead  bodies,  found  tliat  it  was  a  very  difficult  matter  to 
produce  fracture  of  the  skull  by  ordinary  blows  and  that  only 
powerful  blows  were  followed  by  fissures  in  the  occipital,  or 
parietal,  or  "more  frequently  in  the  squamous  portion  of  the 
temporal  bone.  The  dead  scalp  seems  to  have  considerably 
more  power  of  resistance  than  the  living  one,  and  after  its  re- 
moval fissures  of  the  bones  are  more  easily  produced  by 
similar  blows." 

It  is  to  be  determined  sometimes,  whether  the  evidence  of 
fracture  of  the  skull  that  may  be  found  in  human  remains  are 
ante-  or  post-mortem,  or  if  the  latter,  how  produced.  Dr.  S. 
E.  Stone  f  presented  to  the   Norfolk   District  Medical  Society 

*  Edinburgh  Med.  (5r»  Surg,  yournal,  vol.   52,  p.    109. 
f  Bostoti  Med.  6^  Surg,  yournal.   Dec.  26,  1876. 


CRANIAL    INJURIES.  333 

a  skull  presenting  a  well-marked  fracture  at  the  base.  The 
skull  belonged  to  a  skeleton  which  was  found  near  a  brook  in 
Walpole.  It  was  prone  and  partially  concealed  beneath  a 
hedge,  the  right  arm  was  raised  in  advance  of  the  head  which 
pointed  to  the  brook.  "  The  left  arm  lay  under  and  across 
the  body.  The  right  leg  was  extended,  and  the  left  flexed  be- 
neath it.  No  part  of  the  skeleton  was  below  the  level  of  the 
ground  and  no  stone  or  other  hard  substance  could  be  found, 
with  which  the  body  could  have  come  in  contact  in  falling  in 
such  a  manner  as  to  produce  the  fracture.  The  clothing,  with 
the  exception  of  the  feet,  upon  one  of  which  was  found  a  shoe 
and  stocking,  and  upon  the  other  a  stocking  only.  The 
other  shoe  was  found  near  the  head,  while  the  clothing  lay 
mostly  beneath  the  body.  But  little  flesh  was  left  upon  the 
bones,  and  this  was  converted  into  adipocire.  The  locality 
where  the  skeleton  was  found  was  a  most  unfrequented  spot, 
known  to  but  few  persons.  The  fracture  extended  from  a 
point  an  inch  to  the  left  of  the  occipital  protuberance,  in  a 
nearly  straight  line  to  the  posterior  condyloid  foramen,  and 
then  at  an  oblique  angle  forward  to  the  outer  edge  of  the  pos' 
terior  foramen  lacerum." 


Fig.  g. 

The  questions  to  be  decided  were  whether  the  fracture  had 
resulted  from  the  expansion  caused  by  the  freezing  of  water 
which  had  accumulated  in  the  skull  after  the  disappearance  of 
soft  parts,  or  whether  it  had  been  produced  by  violence  be- 
fore death.  Dr.  Stone  believed  in  the  latter  theory,  holding 
that  if  water  had  frozen,  the  expansion  would  have  been  exert- 
ed  upon  all  sides  and  separation  of  the  bone  at  the  sutures 


334  MEDICAL    JURISPRUDENCE. 

would  have  taken  place  instead  of  the  fracture  of  a  strong 
bone.  The  position  of  the  body  favored  the  former  theory 
however. 

Orbital  Wounds. — Several  cases  of  orbital  injuries  with 
fatal  results  are  reported  by  Orfila,  Beck,  and  Smith.  McClane 
the  actor,  was  tried  for  the  murder  of  another  actor  by  thrusting 
his  stick  at  him,  the  point  of  which  entered  tlie  oibit.  Such 
injuries,  as  I  have  said,  in  exceptional  cases  may  not  be  fol- 
lowed at  once  by  death.  A  patient  I  saw  in  consultation  with 
Dr.  Noyes  of  this  city  was  a  man  who  had  been  wounded  while 
hunting,  and  it  was  some  weeks  before  the  serious  nature  of  his 
orbital  wound  was  fully  recognized,  when  upon  examination  a 
long  piece  of  iron  from  the  stock  of  the  gun,  four  or  five  inches 
in  length,  was  found  to  have  entered  the  orbital  cavity,  and 
was  imbedded  in  the  right  frontal  lobe.  Tliis  patient  lived  for 
several  months  after  the  explosion  of  his  gun. 

Prognosis  in  Relation  to  Degree  of  Skull  Injury.* 

— Dr.  Ashurst  presents  two  cases  of  compound  fracture  of  the 
skull  in  children,  which  shows  that  "  the  amount  of  damage 
done  to  the  brain  is  apt  to  be  inversely  proportionate  to  that 
inflicted  upon  the  skull.  In  one  of  the  cases  a  little  girl  was 
injured  by  a  heavy  body  falling  from  a  great  distance  with 
great  momentum,  the  separation  and  removal  of  a  large  portion 
of  bone,  the  occurrence  only  of  "cerebral  irritation,"  the  force 
of  the  blow  being  expended  upon  the  skull,  and  in  this  case 
the  patient's  convalescence  was  uninterupted  and  her  recovery 
was  attended  by  no  cerebral  impairment.  The  second  case  in 
which  the  injury  was  slight,  the  blow  having  been  inflicted 
with  a  shovel,  presented  but  a  very  slight  fracture.  Dr.  Ash- 
urst says  :  "  There  were  at  first  absolutely  no  symptoms  of 
intra-cranial  lesion  ;  and  when  the  occurrence  of  suppuration 
between  the  inner  and  outer  tables  at  the  seat  of  fracture  gave 
rise  to  convulsions,  and  required  the  application  of  the  trephine, 
the  membranes  of  the  brain  were  found  entirely  intact,  and 
with  the  elevation  of  the  depressed  portion  of  bone  the  con- 
vulsions instantly  and  definitively  ceased.  Yet,  at  the  moment 
of  injury,  the  skull  measurably  resisting  the  force  of  the  blow, 
its  effects  were  transmitted  indirectly  (by  the  con f recoup  or 
"  counter-stroke  "  of  the  older  writers)  to  the  substance  of  the 
cerebrum  itself,  where  at  a  very  considerable  depth  some  slight 
laceration  or  contusion  of  the  brain-substance  occurred, — lacera- 

*  Philadelphia  Medical  Times,  Dec  23,  1866,  p.  123. 


CRANIAL  INJURIES.  S^S 

tion  so  slight  as  to  give  no  sign  of  its  presence  until  several 
weeks  afterwards,  and  yet  sufficient  to  prove  the  starting-point 
of  the  large  abscess  which  ultimately  brought  the  case  to  a 
fatal  termination." 

Bullet  Wounds  and  their  Results. — The  occurrence  of 
brain  symptoms  after  the  receipt  of  bullet  wounds  of  the  head 
may  not  be  immediate,  on  the  contrary,  several  weeks  or  a  much 
longer  time  may  ensue  before  cerebral  mischief  follows.  I  know 
of  a  man  who  attempted  suicide  by  firing  four  small  Smith  and 
Wesson  balls  into  the  head — one  just  above  the  right  ear, 
another  above  this,  and  two  through  the  frontal  bone.  The 
patient  appeared  very  comfortable,  ate,  slept,  and  talked  ration- 
ally until  the  twenty-eighth  day,  when  a  rise  of  temperature 
followed  by  headache,  delirium,  and  coma  took  place,  and  he 
died  one  week  later.  Taylor  speaks  of  a  child  who  was  acci- 
dentally injured  by  a  pistol  shot,  which  traversed  both  hemi- 
spheres. No  symptoms  manifested  themselves  for  twenty-six 
days,  and  the  child  died  on  the  twenty-ninth  day. 


Hernia  Cerebri   in  Relation   to  Prognosis. — I 


h' 


was 


called  several  years  ago  to  see  a  child,  who  while  playing  in  a 
closet,  dislodged  a  large  pistol,  which  exploded.  The  ball 
entered  the  forehead,  shattering  the  frontal  bones,  and  as  a 
result  there  was  an  extensive  hernia  cerebri.  If  was  not  until 
two  weeks  afterwards  that  cerebral  symptoms  manifested  them- 
selves, and  the  patient  died  a  few  days  subsequently. 

Dr.  Bush's  Case  of  Pistol  Wound  ot  Brain  with 
Recovery. — Dr.  Bush,  of  Boston,  records  an  interesting 
case  of  a  patient  who  recovered  after  a  pistol  wound  of  the 
head. 

"  G.  B.,  a  stout  German  lad,  sixteen  years  old,  weighing  one 
hundred  and  sixty  pounds,  had  always  been  well,  previous  to 
receiving  the  injury  about  to  be  described. 

"On  June  29th,  while  playing  with  a  younger  companion,* 
the  patient  was  shot  in  the  head,  and  immediately  fell  to  the 
ground  insensible.  He  was  lying  upon  a  sofa,  breathing 
heavily,  with  a  slow  pulse,  the  mouth  drawn  to  the  left,  and  the 
left  arm  and  leg  paralyzed.  It  was  with  difficulty  that  he  could 
be  roused. 

"  Upon  examination  a  small  round  wound,  with  inverted 
edges,  was  found  in  the  forehead,  over  the  center  of  the  right 

*  Boston  Med.  and  Surgical  Journal,  Jan.  12,  18S2,  p.  29. 


336  MEDICAL   JURISPRUDENCE. 

eye  and  an  inch  above  the  eyebrow.  Blood  was  oozing  from 
the  wound.  Without  the  use  of  force,  simply  by  its  own 
weight,  a  probe  passed  into  the  wound,  penetrated  backwards 
to  the  depth  of  two  inches.  The  opening  in  the  skin  was  then 
enlarged  so  as  to  admit  the  tip  of  the  little  finger,  and  with 
this  a  circular  hole  could  be  felt  in  the  skull.  *  *  * 

"  Two  hours  after  the  receipt  of  the  injury  he  became  per- 
fectly unconscious,  and  could  not  be  roused.  Both  pupils 
were  dilated,  the  right  fixed,  the  left  responding  to  light,  and 
later  there  was  vomiting.  *  *  *  Cerebral  substance  in  masses 
as  large  as  a  split  pea  were  noticed  coming  away  with  the 
blood.  Upon  examining  the  opening  in  the  skull  with  a  probe, 
small  particles  of  lead  were  removed. 

"  The  next  day,  June  30th,  the  pulse  was  90,  the  temperature 
TOT. 2°  F.,  the  tongue  coated,  and  the  mind  sluggish,  but  he 
would  respond  when  spoken  to.  He  complained  of  pain  in  the 
head,  which  was  intensified  by  motion.  Vomiting  occurred  at 
intervals.  The  right  pupil  was  largely  dilated  and  did  not 
respond  to  light.  He  stated  that  he  could  not  see  out  of  his 
right  eye.  Ten  grains  of  bromide  of  potassium  Avere  given 
every  three  hours.  *  *  * 

"On  July  3d  there  Avas  a  sero-purulent  discharge  from  the 
wound,  the  pulse  was  too,  the  temperature  was  102.4"  F.,  and 
the  pain  in  the  head  was  increasing.  The  wound  was  oedema- 
tous  and  its  mouth  was  covered  by  a  slough. 

"  On  July  5th,  one  week  from  the  time  he  was  shot,  the  head- 
ache was  of  periodic  character,  and  was  only  noticed  over  the 
right  side  of  the  forehead.  With  the  right  eye  he  could  now 
just  distinguish  objects,  but  could  not  see  clearly,  things  ap- 
pearing as  if  seen  through  a  mist.  *  *  * 

"  On  July  8th  sight  in  the  right  eye  was  perfect,  the  headache 
was  slight  and  local. 

"On  July  loth  the  seat  of  the  cephalalgia  changed  from  the 
from  the  front  to  the  back  part  of  the  head. 

"  I  have  previously  stated  there  was  hemiplegia;  there  was 
loss  of  both  motion  and  sensation,  and  the  skin  of  this  side  was 
colder  than  the  other.  Upon  tickling  the  sole  of  the  left  foot 
the  right  leg  would  be  drawn  up.  He  also  experienced  spas- 
modic pain  from  left  hip  to  the  heel,  and  was  able  to  move  the 
leg  for  the  first  time  since  the  receipt  of  the  injury.  The  right 
pupil  was  still  not  so  sensitive  to  light  as  the  left,  and  the 
mouth  not  so  much  drawn  o  the  left  as  before.  It  was  forty- 
one  days  from  the  time  of  the  accident  before  he  could  move 
his  arm,  and  up  to  this  time  he  could  not  sit  up  in  bed  without 


CRANIAL   INJURIES.  337 

experiencing  nausea,  or  feeling   as  if  "  something  was   rolling 
about  in  his  head."  *  *  * 

"  Now,  four  months  after  the  injury,  he  has  no  cerebral  symp- 
toms, the  paralysis  has  disappeared,  save  in  the  flexors  and 
extensors  of  the  hand,  but  there  is  yet  little  strength  in  the 
muscles  of  the  arm  and  leg,  so  that  he  cannot  walk  far,  for 
fear  of  falling  ;  he  creeps  about  the  floor,  and  even  goes  up 
and  down-stairs  on  his  hands  and  knees.  He  can  walk  when 
any  one  supports  him."  * 

Prognosis    of    Penetrating    Wounds    of    Skull. — 

Dr.  Wharton, f  of  Philadelphia,  presented  recently  an  analysis 
of  316  cases  in  which  foreign  bodies  were  lodged  in  the  brain. 
The  following  figures  are  interesting ; 
Recovered  .  .  .  .  .         i6o  Cases 

Died  .  .  .  .        .    .  •  .  .  156      " 

The  foreign  body  removed  in      .  .  .         106      " 

j  of  these  cases  34  died.  I 

The  foreign  body  was  allowed  to  remain  in  .  .210      " 

j  of  these  122  died,  ) 

(        "  88  recovered.  ) 

The  foreign  body  penetrated  the  frontal  bone  in     132      ** 
j  of  these    58  died,  ) 

(        "  74  recovered.  [ 

The  foreign  body  penetrated  the  parietal  bone  in       58      ** 


j  of  these     27  died, 


31  recovered.  ) 

The  occipital  bone  penetrated  in  .  .  23      ** 

j  of  these     16  died,  ) 

"I        "  7  recovered.  ) 

The  foreign  body  entered  the  temporal  bone  in      ^31      ** 
j  of  these     12  died,  ) 

I       "  19  recovered,  j" 

Wounds  of  the  orbit  were  most  fatal, 

*  Seven  months  after  the  receipt  of  injury,  the  patient  had  perfect  use  of 
both  the  arm  and  the  leg  of  the  side  which  was  affected.  He  could  walk 
without  any  support,  and  had  complete  control  of  the  muscles  of  the  arm 
and  hand. 

\PJiila.  Medical  Tunes,  July  19,  1879,  p.  493. 


338  MEDICAL   JURISPRUDENCE. 

The  statistics  of  the  Medical  and  Surgical  History  of  the 
RebeUion  show,  that  of  186  cases  of  penetrating  wounds  of 
the  cranium,  loi  died,  and  it  is  further  shown  that  in  the  85 
cases  where  the  intruding  body  was  removed  43  recovered. 
When  the  balls  remained  in  the  head  there  is  the  history  of 
epilepsy  and  other  cerebral  symptoms,  paralysis,  head  pain  ; 
and  in  but  four  of  19  cases  no  bad  results  ensued. 

Gross*  has  presented  figures  showing  the  mortality  from 
gunshot  wounds  of  the  skull  and  proves  that  by  proper  surgical 
treatment  the  larger  proportion  recover. 

"Of  224  depressed  gunshot  fractures  of  the  skull,  and  in  90 
operative  measures,  of  these  45  or  50  per  cent.  died.  Of  134 
instances,  on  the  other  hand,  in  which  the  treatment  was  pure- 
ly conservative  and  antiphlogistic,  and  in  43  of  which  the  signs 
of  compression  were  very  doubtful,  61  recovered,  and  73,  or 
54.47  per  cent,  died-;  or  if  the  doubtful  cases,  which  resulted 
in  10  deaths,  be  excluded,  91  cases  of  compression  from  de- 
pressed fractures,  treated  expectantly,  afford  63  deaths,  or  a 
mortality  of  69.23  per  cent.,  a  result  in  favor 'of  operation  by  19 
per  cent." 

In  murder  cases  this  matter  frequently  arises  in  connection 
with  the  question  of  whetlier  or  not  the  patient  received  proper 
treatment  after  the  injury.  Of  course,  with  the  best  treatment 
fatal  results  are  extremely  probable,  and  each  case  dif- 
fers. 

Possible  Method  of  Infliction. — In  cases  of  murder 
it  is  important  to  know  in  what  manner  the  injury  has 
been  inflicted,  the  weapon  used  ;  and  it  is  often  extremely  diffi- 
cult to  arrive  at  the  true  statement  of  facts.  Casper  refers  to 
the  case  of  a  child  who  was  found  dead  in  a  thicket.  The 
mother  was  an  unnatural  one,  and  it  transpired  that  she  mal- 
treated it  upon  every  occasion  and  fed  it  upon  potato  parings 
and  other  refuse.  She  frequently  punished  it,  and  one  witness 
testified  that  the  child  had  been  badly  beaten  the  night  before  its 
death.  The  woman  seized  the  child  and  knocked  its  bare  head 
four  or  five  times  upon  the  floor,  and  hurled  it  into  the  middle 
of  the  room.  The  mother  testified  that  she  gave  the  child  a 
"few  slaps,"  that  it  began  to  whimper  and  groan,  that  she  had 
placed  it  in  bed  where  it  slept  quietly,  and  finally  died  in  about 
an  hour  and  a  half.  She  put  the  child  in  a  basket,  and  left 
the  house,  telling  her  husband  on  her  return  without  the  child, 
that  she  had  left  it  at  a  friend's  house.     She  took  with  her  a 


*  American  "journal  of  Mcdiial  Science,  July  1873. 


CRANIAL   INJURIES.  ^$^ 

"potato  grubber"  to  lead  people  to  suppose  she  was  going  to 
dig  potatoes.  At  the  autopsy  sixty-two  ecchymoses  were  found 
upon  the  child's'  head,  and  a  stellate  fracture  of  the  occipital 
bone  extending  to  the  foramen  magnum  was  found  ;  as  well  as 
a  fissure  of  the  right  parietal  bone,  hyperemia  of  the  brain  and 
an  extravasation  of  blood  at  the  base.  The  statement  of  the 
woman  tkat  she  had  given  the  child  only  one  slap  on  the  side 
of  the  head  was  disbelieved  at  once,  because  of  the  existence 
of  the  extensive  fractures,  and  the  inference  was  that  some 
blunt  instrument  had  been  used.  The  inquiry  in  this  case  was, 
whether  the  cause  of  death  was  from  the  violent  mauling  of  the 
child  and  pounding  it  had  received,  or  whether  the  potato 
grubber  had  been  used,  and,  although  it  was  conceded  that  the 
parietal  fracture  might  have  been  thus  produced,  it  transpired 
that  the  child,  after  the  mother's  ill-treatment  referred  to  above, 
sat  up  and  showed  signs  of  intelligence  for  some  time  ;  it  was 
the  use  of  the  "  potato  grubber "  that  resulted  in  the  more 
serious  fracture  of  the  occipital  bone  and  the  death  of  the 
child. 

The  Character  of  the  Wound. — Macewen,*  has  written 

an  interesting  paper  upon  the  relation  of  wounds  to  the  instru- 
ments inflicting  them,  and  as  his  remarks  are  applicable  to  head 
wounds  as  well  as  others,  I  present  his  conclusions  : 

"  I.  Blunt  instruments  sometimes  produce  scalp  wounds  hav- 
ing straight  outlines  and  sharp  clean  edges,  which  in  these  re- 
spects could  not  be  distinguished  from  wounds  produced  by 
sharp-cutting  instruments. 

"2.  Scalp  wounds,  which  exhibit  entire  hair  bulbs  projecting 
from  the  surface  of  their  sections,  have  been  produced  by  a 
blunt  instrument. 

"3.  Wounds,  exhibiting  nerve  filaments  or  minute  blood  ves- 
sels bridging  the  interspace  between  the  lips  of  the  wound,  to- 
ward the  middle  of  the  depth  of  the  section,  while  the  tissues 
have  receded  all  round  them  below  as  well  as  above,  have  been 
produced  by  blunt  non-penetrating  instruments. 

"4.  When  a  wound,  even  with  sharp  well-defined  margins, 
bears  in  contour  a  resemblance  to  an  osseous  ridge  in  close 
proximity,  there  is  d. probability  \\-\dX  it  was  produced  by  a  blunt 
instrument  through  forcible  impact  against  the  underlying  os- 
seous ridge. 

"5.  Cut  hairs  found  in  the  immediate  vicinity  of  a  wound  are 

*  Glasgow  Medical  Journal,  Jan.,  1879. 


340  MEDICAL   JURISPRUDENCE. 

valuable  aids  in  determining  whether  a  sharp  or  a  blunt  instru- 
ment has  been  made  use  of. 

"6.  As  to  the  diagnosis  between  wounds  produced  by  instru- 
ments of  the  knife  kind  and  other  sharp-edged  substances,such 
as  glass,  earthenware,  etc.,  no  dependence  can  be  placed  on  the 
mere  regularity  of  outline  or  sharpness  of  edge,  or  the  re- 
verse. 

"7.  Sharp  clearly-defined  wounds  in  certain  cases  present 
peculiarities  in  their  terminations  which  may  be  sufficient  to 
enable  a  probable  diagnosis  as  to  whether  they  were  produced 
by  a  knife  or  a  portion  of  glass  or  earthenware. 

"8.  The  same  instrument,  used  by  the  same  person  in  deliv- 
ering several  successive  blows,  may  produce  wounds  of  differ- 
ent character." 

Accidental  Homicidal  Injury. — It  may  be  necessary 
in  some  cases  to  determine  whether  death  results  from 
a  fatal  wound,  from  an  accidental  fall,  or  by  the  patient 
being  hurled  against  a  wall.  In  a  general  row  or  disturbance 
it  is  often  important  to  consider  whether  the  individual  was 
accidentally  killed  or  maliciously  struck  upon  the  head  by 
another.  As  Casper  has  shown,  if  most  of  the  participants  are 
drunk  very  little  reliance  is  to  be  placed  in  their  stories.  In 
such  cases  we  are  to  carefully  determine  the  nature  of  the 
wound.  If  it  is  associated  with  others,  it  may  or  may  not  be 
the  cause  of  death.  The  character  of  the  fracture,  and  the  evi- 
dence of  violence  are  to  be  investigated.  It  may  appear  that  the 
pathological  appearances  are  too  violent  to  have  originated  in 
an  ordinary  fall  or  vice  versd.  The  sharpness  of  the  edge  of 
the  wound  should  be  examined,  and  its  shape  in  relation  to  ob- 
jects that  might  have  inflicted  it.  In  cases  where  people  are 
injured  in  brawls,  I  agree  with  Beck  that  it  is  always  best  to 
*'  lean  towards  the  accused,  unless  the  proof  of  malice  is  con- 
clusive." 

Civil  Suits  for  Damages. — Medical  men  are  called 
upon  to  ex])ress  opinions  and  give  testimony  regarding  personal 
examinations  they  may  have  made,  not  only  in  criminal 
questions,  but  in  civil  suits  as  well.  In  certain  accident 
cases  the  claim  is  made  that  the  plaintiff  has  received  a  blow 
upon  the  head  which  has  given  rise  to  permanent  injury.  Some 
times  the  cause  of  such  injury  is  due  to  the  fall  of  building  ma- 
terial, at  others  the  j)laintiff  has  himself  fallen  from  an  insecure 
sidewalk,  vehicle  or  elevator,  and  of  course  a  suit  for  damages 
is  the  result.     The   injured  person  may  present  himself  for  ex- 


CRANIAL    INJURIES.  341 

amination,  with  a  well  marked  history  of  nervous  symptoms  di- 
rectly traceable  to  the  blow  or  fall,  or  he  may  bear  suggestive 
scars,  or  very  often  his  unsupported  story  is  all  we  have  to  guide 
us.  It  is  not  rare  to  find  fraud  and  imposture.  In  one  case  I  was 
called  to  examine  a  well-marked  migraine,  connected  beyond 
doubt  with  menstrual  irregularities,  were  said  to  be  due  to  a 
head  injury;  in  another  the  claim  for  excessive  damages 
was  made  by  a  confirmed  epileptic,  whose  disease  had  existed 
for  years,  and  who  insisted  that  his  disease  was  received  by  and 
followed  an  accident. 

Infanticide  by  Head  Injury. — We  are  sometimes 
obliged  to  determine  the  significance  of  cranial  injuries 
as  the  result  of  infanticide,  and  are  to  distinguish  be- 
tween cases  where  a  child  has  been  killed  by  its  inhu- 
man mother,  and  those  where  an  accident  shortly  after  birth 
has  been  the  cause  of  death.  It  will  not  do  to  disregard  the 
fact  that  fractures  of  the  skull  may  occur  during  labor,  as  the 
result  of  the  use  of  the  forceps  or  of  mechanical  obstruction, 
the  mother  perhaps,  having  a  deformed  pelvis  ;  but  these  are 
rare,  and  when  they  occur  it  is  almost  always  possible  to  find 
the  method  of  causation,  either  by  examination  or  by  the  testi- 
mony of  the  physician.  The  victims  of  infanticide  usually  pre- 
sent other  signs  of  violence  than  fractures,  which  differ  from 
those  that  are  produced,  for  instance,  by  the  forceps,  from  the 
fact  that  they  are  attended  by  excessive  laceration  of  the  brain 
and  other  local  injuries.  Fractures  produced  by  forceps  are 
due  primarily  to  defective  ossification,  and  the  anterior  cranial 
bones  are  involved,  while,  as  Ogston  has  pointed  out,  the  occi- 
pital bone  usually  escapes.  Two  or  three  cases  are  presented  by 
this  author  which  are  of  interest.  In  one  it  was  found  that  in 
addition  to  fractures  of  the  parietal  and  frontal  bone  the  sides 
of  the  head  and  face  were  flattened,  and  the  marks  of  large  shoe 
nails  were  visible  on  one  cheek.  The  mother  had  killed  her 
child  by  trampling  it  in  the  cow-house  where  it  was  born. 


CHAPTER  VIII. 

SPINAL    INJURIES. 

General  Anatomy  of  the  Spinal  Column.— The  spinal 
column  consists  of  a  number  of  closely  articulated  bones  be- 
ginning at  the  base  of  the  skull  and  extending  downwards, 
terminating  in  the  coccyx.  The  bones  are  bound  together  by 
ligaments  and  muscles,  and  form  a  canal  in  which  lie  the 
spinal  cord  and  its  coverings.  The  bones  of  the  spinal  column 
are  of  five  divisions — cervical,  dorsal,  lumbar,  sacral  and 
coccygeal.  Those  above  being  the  cervical,  seven  in  number  ; 
those  next  below  being  the  dorsal,  of  which  there  are  twelve, 
the  next  lowermost  are  the  lumbar,  of  which  there  are  five, 
while  below  are  the  sacrum  and  coccyx  which  in  the  adult 
are  practically  two  bones.  The  vertebrae  have  peculiar  charac- 
teristics, especially  the  cervical  and  lumbar,  the  latter  being 
the  largest,  while  the  dorsal  are  comparatively  small,  but  they 
increase  in  size  from  above  downwards.  The  dorsal  vertebrae, 
it  will  be  remembered,  furnish  articulations  for  the  ends  of  the 
ribs.  At  the  posterior  part  of  the  s])inal  column  will  be  found 
spinous  processes  more  or  less  pronounced  ;  that  of  the  seventh 
cervical  being  known  because  of  its  great  development  as  the 
vertebra  promiucns. 

Ligamentous  Attachments. — Laterally  the  vertebrae  are 
provided  with  transverse  processes  which  serve  as  points  of 
attachment  for  ligaments,  and  in  the  dorsal  region  contain  ar- 
ticulations for  the  tubercle  of  the  corresponding  rib.  In  the  cer- 
vical region  the  two  upper  vertebrae  are  very  important  because 
of  the  duties  they  perform.  The  first  or  atlas  supports  tlie  skull ; 
it  is  divided  by  a  transverse  ligament  into  two  segments,  one 
receiving  the  odontoid  process  of  the  axis,  and  the  posterior  is 
filled  by  the  spinal  cord.  The  second  cervical  vertebra  or  axis 
articulates  with  the  atlas  by  means  of  the  odontoid  process 
which  projects  upwards  through  the  opening  before  described, 
and  below  with  the  next  cervical  vertebra  by  means  of  facets. 
All  of  the  vertebrae  are  separated  by  discs  of  cartilage 
which  are  undoubtedly  provided  to  prevent  the  transmis- 
sion  of  shock.       The   spinal  cord  wliich   is  contained   in  the 


SPINAL    INJURIES.  343 

spinal  canal  extends  below  as  far  as  the  first  lumbar  vertebra, 
and  from  it  pass  nerves  to  each  side  of  the  body  to  the  ex- 
tremities and  trunk.  In  the  cervical  region  a  number  of  the 
nerves  after  leaving  the  cord  join  to  form  the  brachial  plexus 
which  is  formed  by  the  juncture  of  the  four  lower  cervical  and 
the  first  dorsal  nerves ;  these  further  divide  up  into  three 
trunks  which  supply  the  shoulder  and  upper  part  of  the  chest 
and  the  arm  and  forearm.  In  the  lumbar  and  sacral  regions 
we  find  other  great  branches  which  supply  the  pelvic  organs 
and  the  lower  extremities. 

Localizatiou  of  Spinal  Injuries. — A  reference  to  the 
appended  cut,  which  is  taken  from  Gower's,  will  enable  the 
reader  to  understand  the  nerve  supply,  and  it  will  be  recog- 
nized at  a  glance  how  the  injury  of  a  particular  part  of  the 
spine  may  produce  various  alterations  of  function  in  remote 
parts. 

Inyestlng  Membranes  of  the  Cord. — The  spinal  cord 
is  surrounded,  as  is  the  brain,  by  the  pia  mater,  arachnoid 
and  dura  mater,  and  there  is  communication  between  the 
ventricular  spaces  of  the  brain  and  the  arachnoid  cavities 
in  the  spinal  canal,  so  that  the  cerebro-spinal  fluid  may  accu- 
mulate or  be  diminished  in  quantity  under  varying  conditions. 
The  dura  mater  is  separated  from  the  wall  of  the  bony  canal 
by  arjolc:  tissue  and  vascular  plexuses,  and  contains  perfora- 
tions thi'Oiig/.  which  the  spinal  nerves  pass  on  their  exit  to 
othc?  parts  of  the  body.  Filaments  pass  to  the  cord  from  the 
araclmoic  to  keep  it  in  its  place.  The  nerve  roots  consist  of 
two  fro;  \  each  sogment,  an  anterior  and  posterior,  which  go 
1  form  the  main  trunk.  At  the  lower  part  of  the  cord  the 
nerve  roots  descend  almost  vertically  to  pass  out  of  the  various 
foramina  of  the  sacrum,  while  the  cord  ends  in  a  bundle 
of  filaments  which  compose  the  cauda  equina. 

Anatomy  of  tlie  Spinal  Cord. — At  two  important 
points  in  the  cervical  and  lumbar  region,  we  find  enlargements 
of  the  cord  which  correspond  to  the  emergence  of  important 
bundles  of  nerves  going  to  the  upper  and  lower  extremities, 
while  in  the  dorsal  region  the  cord  is  of  comparatively  small 
size.  The  spinal  cord  consist.:  of  various  bundles  of  fibres 
going  to  and  coming  from  the  brain,  and  a  central  collection 
of  gray  nervous  substance  which  at  its  anterior  part  contains 
large  cells,  having  a  special  motor  and  trophic  function, 
while  posteriorly  there  are  prolongations  of  gray  matter  which 


344 


MEDICAL   JURISPRUDENCE. 


Motor. 


(Qlnai-  lowest) 


Sensory. 

/Neck  and  Scalp 

>Nock  and  Shou/aifii 

Shoulder 

Arm 

Hand 


Reflex 


Front  of  Thorax 
Ensifonn  atca 


JEnsif 


Extensors,  knee 
>Addnctor<i"] 

Abductors    j 

Eirtensori'C?)] 
Flexora,  knee  (?) 

Muscles   of    leg 
moving  foot 

Vrineal  and  Anal 
muudes 


Abdomen 
(UmbUicas  lOlh), 


I  Buttock,  upper 
f    pai-t 

1 

yOioin  and  scrotum 
^     (front) 

outer  oide 


Thigh- 


inner  side 
Leg.  inner  side 
Buttock,  lower 
part 

■•(Back  of  Thigh 

^  I     except 
Foot  J  "*"<"■  P^ 

iPcrineum  and 
Anus 


,8kin  from  cOcc^ 
to  anus 


Scapulae 


Epigastric 


Abdominis 


^Oemasterfe 


fSnte  .r</«s 


iG>at«al 


Anile  elonSf 
Plants 


Fig.  lo. 

Scheme  of  Spinal  Symptoms. 

(Gower.) 


SPINAL   INJURIES.  345 

play  an  equally  important  part  of  a  sensory  nature.  The 
white  matter  which  surrounds  the  central  gray  substance  and 
is  composed  of  nerve  fibres  is  divided  up  into  regions  which 
have  special  functions,  and  these  are  designated  as  columns  ; 
and  in  each  half  of  the  spinal  cord  which  is  divided  by  an  an- 
terior and  posterior  fissure,  we  find  an  anterior  column,  a  lat- 
eral column,  and  a  posterior  column.  Roughly  speaking  we 
find  that  the  two  former  are  concerned  in  the  transmission  of 
motor  impulses,  while  the  latter  are  devoted  to  the  conduction 
of  sensory  impulses.  That  the  emergence  of  motor  impulses 
takes  place  in  the  anten'or  nerve  roots,  and  the  conduction  is 
efferent  ;  while  sensory  impressions  are  carried  to  the  cord  by 
the  posterior  roots,  and  are  further  conducted  by  the  posterior 
columns,  and  in  the  dorsal  region  by  the  lateral  colunms. 

Pathologically  considered,  we  find  that  disease  of  the  an- 
terior columns  and  the  nerve  cells  of  anterior  gray  matter,  is 
followed  by  paralysis  and  muscular  wasting  ;  that  disease  of 
the  lateral  columns,  by  loss  of  power  and  by  rigidity,  contrac- 
tions, and  increased  reflex  excitability  ;  and  that  degeneration 
of  the  posterior  columns  is  manifested  by  sensory  disturbances 
as  anesthesia,  pain  ;  and  loss  of  co-ordinating  power.  We  also 
find  that  disease  at  different  levels  of  the  spinal  cord  gives  rise 
to  special  symptoms  dependent  upon  the  involvem.ent  of  vari- 
ous important  nerves  supplying  particular  organs.  Thus  dis- 
ease of  the  cervical  region  is  very  likely  to  produce  ocular 
difficulties,  interference  of  the  action  of  the  diaphragm,  par- 
alysis of  motion  and  sensation  of  the  upper  extremities  and 
of  the  shoulder  and  neck  ;  disease  of  the  dorsal  region  pro- 
duces more  or  less  paralysis  of  motion  and  sensation,  of  the 
intercostal  muscles  and  thoracic  walls,  so  that  difficulty  of 
breathing  results,  and  in  the  lumbar  region  we  find  paralysis 
of  the  lower  extremities  and  of  the  bladder  and  bowels,  with 
more  or  less  disturbance  of  sensation,  and  with  affections  of 
the  various  reflexes  of  the  lower  extremities. 

The  medico-legal  importance  that  may  be  attached  to  spinal 
injury  is  immense,  and  probably  the  greater  proportion  of 
actions  for  damages  that  arise  in  our  courts  are  based  upon 
alleged  injury  to  the  vertebral  column  and  its  contents. 

Forms  of  Injury.— Let  us  see  how  trausmatisms  are 
likely  to  produce  mischief.  Brodie*  considers  the  surgical 
accidents  of  the  spinal  column  to  be  as  follows  : 

I.  Fracture  without  displacement. 

*  Med,  Chir.  Trans,   vol.  xx. ,  p.  120  and  p.  3. 


346  MEDICAL    JURISPRUDENCE. 

2.  Fracture  with  depression  or  displacement,  causing  pressure 
on  the  cord. 

3.  Fractures  compHcated  with  dislocation. 

4.  Dislocations  not  complicated  with  fracture. 

5.  Extravasations  of  blood  on  the  surface  of  the  membranes 
of  the  spinal  cord. 

6.  A  narrow  clot  of  extravasated  blood  is  sometimes  dis- 
covered within  the  substance  of  the  spinal  cord. 

7.  Laceration  of  the  spinal  cord  and  its  membranes. 

8.  The  minute  organization  of  the  spinal  cord  may  suffer 
from  a  blow  inflicted  upon  the  spine  even  where  there  is  nei- 
ther fracture  nor  dislocation,  and  where  the  investing  mem- 
branes do  not  appear  to  participate  in  any  way  in  the  effects 
of  the  injury. 

Manifestation  of  Symptoms. — All  of  these  conditions 
are  likely  to  be  found  as  the  result  of  injury,  and  as  a  result  we 
are  furnished  with  a  train  of  symptoms  which  vary  as  to  sever- 
ity and  prognosis.  In  some  instances  the  symptoms  are  of 
immediate  appearance,  and  subside  gradually  ;  in  others  there 
is  a  progressive  disease  of  the  spinal  cord  due  to  so-called 
compression  myelitis.  We  find  as  a  consequence  various  sen- 
sory, motor  and  trophic  disorders  which  are  manifested  in 
aneesthesia,  or  hypergesthesia,  paralysis,  spasms  or  contracture, 
and  atrophy.  These  may  appear  gradually  one  after  the  other, 
or  almost  simultaneously,  and  depend  upon  the  extent  of  the 
injury  and  destruction  of  the  cord. 

Fracture  without  Displacement. — Fracture  without 
displacement  may  occur  in  various  situations,  but  the  most 
common  site  is  the  dorsal  region. 

Dislocation. — Dislocation  may  occur  immediately  as  the 
result  of  violence  or  as  the  result  of  bone  disease,  with  the 
destruction  of  vertebrae,  and  this  is  of  secondary  causation. 
The  most  common  site  is  the  cervical  region  when  the  disloca- 
tion follows  the  accident  at  once,  or  when  there  is  caries  the 
dorsal  vertebrse  are  dislocated  more  often  than  the  others. 

A  blow  upon  the  back  of  the  neck  without  external  marks  of 
injury  may  give  rise  to  serious  bone  injuries,  such  as  fracture 
and  consecutive  atrophy,  so  that  at  a  remote  time,  perhaps, 
evidences  of  very  serious  spinal  disease  of  a  progressive  char- 
acter may  result  in  the  patient's  demise.  I  have  seen  three 
cases  in  which  the  injury  in  the  cervical  region  which  at  first 
was   considered   trivial   developed    finally   in    two    in    caries 


SPINAL    INJURIES.  347 

and  dislocation  of  these  vertebrae,  and  in  the  third,  where  a 
fracture  of  the  transverse  process  of  the  axis  occurred  so  that 
the  most  intense  cervico-brachial  neuralgia  was  produced. 

Case  LVII. — In  one  of  these  cases,  J.  B.  M.,  a  blow  was 
received  from  a  club  in  the  hands  of  a  highwayman,  and 
beyond  the  production  of  a  short  period  of  unconscious- 
ness succeeded  by  headache,  vertigo  and  pain,  loss  of 
power  and  numbness  in  the  arm.s  and  hands  which 
moderated  and  disappeared  within  a  few  weeks  ;  no  more 
serious  symptoms  existed,  and  the  would-be  assassin  received  a 
comparatively  light  punishment.  In  the  course  of  a  year,  how- 
ever, the  pain  in  the  arms  returned,  and  with  it  there  was  a 
loss  of  power  connected  with  very  great  wasting  of  all  the  mus- 
cles of  the  arms.  I  first  saw  him  in  April,  iS8o,  two  years 
after  the  injury,  and  found  beyond  the  atrophy,  which  was 
extreme  and  involved  a  great  loss  of  substance  of  the  posterior 
cervical  muscles,  and  left  deltoid,  there  was  a  peculiar  deformity 
resulting  apparently  from  the  anterior  dislocation  of  the  third 
or  fourth  cervical  vertebra  so  that  a  depression  existed  and  the 
thyroid  cartilage  was  very  prominent,  and  the  chin  was  thrown 
upwards  and  forwards.  The  upper  extremities  in  which  he 
told  me  the  wasting  began,  present  the  appearance  of  those  in  a 
person  suffering  in  an  advanced  form  of  progressive  muscular 
atrophy.  There  is  a  tendency  to  flexion  of  the  fingers  and 
great  hollowness  of  the  palms,  the  flexor  tendons  being  quite 
prominent  and  the  interosseous  spaces  are  deepened.  He  can- 
not put  the  left  hand  upon  the  top  of  his  head,  and  when  he 
raises  either  hand  there  is  aggravation  of  the  severe  pain  which 
he  constantly  complains  of.  His  co-ordinating  power  and 
sense  of  localization  are  affected,  and  he  can  "  do  nothing 
without  the  aid  of  his  eyes."  He  cannot  pick  up  a  pin  nor 
touch  his  nose  even  when  his  eyes  are  opened,  tactile  sensation 
is  not  good,  the  tendinous  reflexes  are  everywhere  exaggerated, 
he  is  irritable  and  annoyed  by  noises  and  is  inclined  to  cry 
upon  the  slightest  provocation.  The  pupils  were  contracted 
when  I  last  examined  him,  and  did  not  respond  readily.  A 
significant  feature  of  the  case  is  the  difficulty  he  experiences 
when  swallowing. 

Fracture  Complicated  with  Dislocation.— It  occa- 
sionally happens,  as  in  the  case  reported  by  Sir  Charles  Bell, 
that  peculiar  injuries  may  give  rise  to  extraordinary  spinal 
symptoms,  and  in  some  cases  the  fall  of  a  person  who  has  been 
assaulted  may  account  for  a  vertebral  dislocation,  which  it  is 


34^  MEDICAL   JURISPRUDENCE. 

supposed  could  have  been  produced  in  no  other  way  than  by 
the  direct  effect  of  the  injury  itself.  In  Bell's  case  "a  man 
was  making  a  violent  effort  to  impel  a  wheelbarrow  from  the 
street  upon  the  raised  foot-pavement,  when  the  wheelbarrow 
suddenly  went  before  him  and  he  fell  with  his  chin  upon  the 
curbstone.  He  was  dead  in  a  few  seconds.  The  processus 
dentatus  was  found  to  have  crushed  the  spinal  cord,  the  liga- 
ments having  given  way." 

Cooper  reports  an  accident  of  the  same  kind,  not  immediately 
fatal,  as  the  result  of  a  fall,  in  which  the  first  cervical  vertebra 
was  broken. 

Potts'  Disease. — The  production  of  Potts'  disease  is  due 
to  falls,  blows  upon  the  back  or  mechanical  violence  usually 
directly  applied,  or,  it  may  be  due  to  disease  of  bone  without 
any  noticeable  injury.*  The  distinguishing  feature  of  Potts' 
disease  is  the  existence  of  kyphosis  or  bending  of  the  vertebral 
column  so  that  a  deformity  results,  the  anterior  part  of  one  or 
more  of  the  vertebrae  (the  bodies)  being  destroyed,  and  in  con- 
sequence the  spinal  processes  are  thrown  out  posteriorly  so 
that  a  peculiar  and  familiar  deformity  results.  As  a  conse- 
quence of  such  disease  the  spinal  cord  and  its  membranes  are 
impinged,  especially  at  the  anterior  point,  and  what  is  known 
as  compression  myelitis  results. 

Compression  Myelitis. — The  commencement  of  the  dis- 
ease is  indicated  by  pain  which  is  due  to  irritation  of  the 
meninges  and  posterior  nerve  roots  so  that  there  is  great  ten- 
derness, darting  pains,  upon  movement  of  the  spine  and 
when  the  erect  position  is  kept.  In  the  latter  case  the  weight 
of  parts  above  presses  the  diseased  vertebrae  together,  and  the 
pain  is  explained  in  this  way.  After  a  short  period  of  sensory 
irritation  we  find  that  there  is  loss  of  power  due  to  the  pressure 
made  upon  the  anterior  part  of  the  spinal  column.  The  skin 
is  at  first  the  seat  of  hyperaesthesia,  and  subsequently  of  anaes- 
thesia, which  is  found  in  isolated  areas,  and  perhaps  eventually 
becomes  general.  There  is  atrophy,  the  response  of  the 
muscles  to  electricity  is  very  feeble,  and  the  initial  loss  of  power 
is  afterwards  succeeded  by  a  rather  pronounced  paraplegia 
without  rigidity,  the  muscles  being  flabby,  but  after  a  time  they 
grow  more  rigid  as  the  lateral  columns  of  the  spinal  cord  suffer, 
the  tendon  reflexes  being  exaggerated.     There  is  much  irregu- 

*  In  young  persons  generally.  In  older  persons  the  disease  is  almost 
always  traumatic. 


SPINAL    INJURIES.  349 

larity  about  the  manifestation  of  the  motor  symptoms,  and  it  will 
be  seen  that  such  must  be  the  case  from  the  unequal  pressure 
made  upon  the  contents  of  the  spinal  canal.  The  striking  fea- 
tures  of  compression  myelitis'  are  the  reflex  symptoms  ;  and 
tremors,  jerkings  and  active  dorsal  clonus  are  produced  by  the 
slightest  form  of  excitement.  The  functions  of  the  bladder 
and  rectum  are  disturbed,  and  incontinence  of  urine  and  feces 
takes  place. 

According  to  Erb  the  cases  may  be  divided  into  two  classes 
as  to  recovery.  Some  patients  under  proper  treatment  show 
signs  of  improvement  and  slowly  recover,  while  others  grow 
steadily  worse  and  cystitis  and  bed-sores,  exhaustion  and  death 
follow.  In  cases  of  Potts' disease  there  is  usually  some  projec- 
tion of  the  vertebra  at  a  very  early  period,  and  wlien  the  patient 
stands  erect  a  more  or  less  conspicuous  prominence  is  found 
corresponding  to  the  seat  of  disease,  and  pressure  produces 
great  pain. 

The  situation  and  character  of  the  deformity  in  Potts'  dis- 
ease and  its  association  with  changes  in  the  posture  and  move- 
ments of  the  patient  should  be  critically  investigated  in  instances 
where  suit  is  brought  for  damages,  for  unprincipled  indivi- 
duals who  coach  a  plaintiff  are  very  apt  to  furnish  him  with 
suggestions  which  though  at  first  sight  indicate  veritable 
vertebral  disease,  are  out  of  consonance  with  the  behavior  of 
the  pretender.  In  one  outrageous  case  with  which  I  am  familiar 
a  prominent  seventh  cervical  spine  was  the  alleged  angularity, 
but  was  in  no  sense  the  result  of  disease  ;  and  it  may  be  wise 
in  view  of  the  possibility  of  this  claim  being  urged  in  other 
cases,  to  call  attention  to  the  fact  that  in  many  hysterical  and 
anemic  women  as  the  result  of  debility  and  relaxation  to  find 
the  vertebra  prominens  more  than  ordinarily  conspicuous,  and 
perhaps  we  may  discover  that  tenderness  which  is  so  universal 
in  cases  of  spinal  anemia. 

Dr.  Gibney,  of  New  York,  has  written  extensively  in  his 
practical  way  upon  doubtful  cases  of  Potts'  disease,  where  the 
early  symptoms  have  not  only  been  mistaken  for  those  of  other 
troubles,  but  where  temporary  functional  troubles  have  been 
dignified  as  true  cases  of  vertebral  disease.  In  undoubted 
caries  of  the  vertebra,  and  especially  the  traumatic  variety,  par- 
ticularly when  the  upper  vertebrse  are  affected,  we  find  paralysis 
to  be  an  early  and  pronounced  symptom.  Of  one  hundred 
and  eighty-nine  cases  collected  by  Gibney,  in  which  the  verte- 
bras above  the  middle  dorsal  region  were  involved,  sixty-two 
instances  of  paralysis  occurred.     It  must  be  remembered  that 


3SO  MEDICAL    JURISPRUDENCE. 

in  the  majority  of  the  cases,  especially  those  occurring  early  in 
life,  there  is  a  strumous  element  which  predisposes. 


Case  LVIII. — In  a  rather  interesting  case  recently  tried  in 
this  city,  it  was  alleged  that  a  gentleman  who  had  been  injured 
was  the  subject  of  Pott's  disease  resulting  from  a  sprain,  which 
was  produced  by  his  attempt  to  control  a  pair  of  spirited  horses 
when  his  wagon  ran  into  a  hole  in  one  of  the  public  thor- 
oughfares. The  accident  occurred  upon  a  rainy  night,  and  he 
was  exposed  for  many  hours  to  the  rain,  his  clothes  became 
wet  through,  and  he  did  not  change  them  for  some  time  after- 
wards. His  only  injury,  so  far  as  was  shown  by  the  evidence,  was 
a  sprain,  caused  by  his  being  drawn  half  way  across  the  dash- 
board. From  the  time  of  the  accident  he  complained  of  severe 
spinal  pain,  which,  however,  was  not  localized  until  a  few  days 
subsequently.  I  found,  however,  when  I  examined  him  that  he 
had  pain  at  several  points  in  the  spinal  column,  more 
intense,  perhaps,  in  the  lumbar  region.  Within  a  few  weeks 
he  began  to  develop  symptoms  indicative  of  locomotor  ataxia, 
and  at  the  time  of  the  trial  he  presented  the  classical  features 
of  that  well-known  disease,  his  tendon  reflex,  however,  being 
exaggerated,  suggesting  invasion  of  the  lateral  columns  of  the 
spinal  cord.  A  distinguished  physician  who  had  attended  him 
in  the  beginning  claimed  that  he  had  an  angular  projection,  but 
neither  Drs.  Hammond,  Clymer,  Stimson  or  myself  could  find 
the  least  deform.ity,  and  taking  into  account  the  fact  that 
although  the  malady  had  existed  for  so  long  a  time  there 
was  no  paralysis  whatever,  we  excluded  the  idea  of  Pott's  dis- 
ease, and  practically  agreed  that  it  was  a  hybrid  form  of  scle- 
rosis, traceable  entirely  to  the  exposure  on  the  night  of  the 
accident. 

In  cases  where  Pott's  disease  has  been  claimed  to  be  due  to 
an  injury  of  the  back,  it  commonly  happens  that  there  has  been 
trouble  before  the  accident,  and  though  in  very  rare  cases  an 
inflammatory  process  beginning  in  the  joints  as  the  result  of  a 
sprain  may  be  found,  it  is  not  common  for  any  extension  to 
take  place. 

Extravasation  in  the  MeniTbranes  of  the   Cord. — 

5.  Extravasation  into  the  membranes  of  the  cord  may  follow  a 
fracture  or  severe  shock,  such  as  a  fall  upon  the  buttocks  or 
upon  the  back,  or  in  consequence  of  wounds  made  by  sharp 
instruments.  The  appearance  of  symptoms  is  immediate,  and 
if  the  hemorrhage  be  extensive  the  patient  may  be  deprived  of 


SPINAL    INJURIES.  35 1 

power,  and  there  is  paralysis  of  the  body  below  the  level  of  effu- 
sion. In  some  cases  the  appearance  of  symptoms  is  gradual  and 
marked  by  pain  and  rigidity  of  the  back,  pain  in  the  legs, 
ansesthesia,  or,  perhaps  hyperaethesia  ;  darting  pains,  formica- 
tion and  other  symptoms  of  irritation  of  the  posterior  nerve 
roots.  The  loss  of  power  which  follows  is  of  a  light  grade, 
unless  there  be  compression-myelitis  and  invasion  of  the 
spinal  cord.  The  functions  of  the  bowels  and  bladder  are 
affected  and  reflex  excitability  is  usually  lowered.  We  may 
localize  the  hemorrhage  by  the  existence  of  spinal  tenderness, 
and  by  the  involvement  of  the  upper  extremities,  the  presence 
of  pupillary  changes,  headache,  respiratory  embarrassment, 
etc.,  when  the  cervical  region  is  involved.  The  prognosis  is 
not  necessarily  bad  unless  there  be  extending  inflammation  to 
the  cord.  A  serious  feature  of  the  trouble  is  the  existence  of 
the  clot  in  the  upper  part  of  the  cord.  The  prognosis  is  then 
apt  to  be  exceedingly  bad. 

Sir  Astley  Cooper  reports  the  case  of  "  a  boy,  aged  twelve, 
who  received  a  violent  jerk  of  his  neck  by  a  cord  thrown  over 
his  head  as  he  was  swinging  forward  in  a  swing.  He  felt  no  bad 
effects  at  the  time,  but  afterwards  his  limbs  became  weak  and 
his  neck  stiff.  In  eleven  months  this  increased  to  palsy,  and 
he  died  at  the  end  of  twelve  months  after  the  injury.  A  large 
quantity  of  extravasated  blood  was  found  in  the  spinal  canal 
betwixt  the  bone  and  the  theca  vertebralis." 

Clot  in  the  Cord  Itself. — 6.  When  the  spinal  cord  is  in- 
volved and  contains  a  clot,  the  symptoms  are  much  more  se- 
vere and  dangerous  and  much  more  likely  to  be  followed 
by  permanent  symptoms,  indicative  of  degeneration.  The 
early  symptoms  need  not  necessarily  be  alarming  and  may 
be  of  a  light  grade  ;  but  in  the  midst  of  an  apparent 
amelioration  after  injury,  a  sudden  paralysis  may  make  its  ap- 
pearance, and  in  this  case  it  is  probable  that  a  secondary  pro- 
cess of  softening  has  caused  the  rupture  of  a  blood  vessel.  The 
paraplegia  resulting  from  spinal  apoplexy  is  usually  complete, 
if  the  escape  of  blood  be  at  all  considerable,  and  its  extent 
depends  very  much  upon  the  seat  of  the  lesions.  At  a  high 
level  we  may  have  the  respiratory  and  oculo-motor  symptoms,  as 
well  as  those  indicative  of  disturbance  of  the  medulla,  and  as  a 
consequence  we  find  marked  temperature  changes  and  affec- 
tions perhaps  of  the  cranial  nerves  ;  if  the  hemorrhage  be 
small  and  confined  to  a  limited  portion  of  the  spinal  cord,  of 
course  there  need  be  little  more  than  local  degeneration  and  its 


352  MEDICAL  JURISPRUDENCE. 

consequences.  Wilks  refers  to  a  case  in  which  a  blow  upon 
the  spine  caused  simply  an  effusion  of  blood  into  the  gray  matter 
of  the  cord  and  the  primary  symptoms  were  those  indicative  of 
sensory  disturbance,  and  he  calls  attention  to  the  well  recog- 
nized fact  that  very  light  ruptures  of  bloodvessels  in  this  re- 
gion are  apt  to  be  followed  by  extension  of  the  lesion,  and  con- 
sequently of  the  symptoms. 

Laceration  of  the  Spiual  Cord  and  its  Membranes. 

— 7.  Laceration  of  the  spinal  cord  and  its  membranes  is  a  very 
rare  accident  and  probably  never  occurs  without  vertebral  injury. 
It  is  possible  for  penetrating  wounds  to  produce  such  mischief 
and  as  a  consequence  we  are  almost  immediately  furnished 
with  a  train  of  such  manifestations  as  spinal  hemiplegia  or  par- 
aplegia, the  former  resulting  from  a  one  sided  wound  which 
produces  severance  of  the  motor  tracts  with  disturbance  of 
sensation  upon  the  other  side  of  the  body.  In  fact,  whether  the 
one  sided  injury  to  the  spinal  cord  depends  upon  penetrating 
wounds  or  lateral  fractures  with  displacement  of  fragments, 
the  symptoms  are  apt  to  be  those  of  the  peculiar  paralysis  orig- 
inally described  by  Brown-Sequard. 

In  all  cases  of  spinal  injury  the  appearance  of  symptoms  of 
course  depends  upon  the  degree  to  which  the  spinal  cord  is  im- 
pinged upon,  either  by  the  products  of  inflammation  started  in 
the  meninges  or  coverings,  or  in  the  cord  itself.  Dislocated 
or  fractured  vertebrae  are  very  apt  to  be  followed,  at  first,  by 
meningeal  symptoms,  such  as  pain  and  nerve  irritation,  and 
afterwards  by  the  production  of  symptoms  referable  to  the  cor- 
tex of  the  spinal  cord  ;  and  among  the  later  we  find,  as  a  rule, 
that  the  earliest  is  an  affection  of  motor  power,  which  is  suc- 
ceeded perhaps  by  rigidity  and  contractures,  and  by  an  increase 
of  the  reflex  excitability  of  the  tendons.  When  the  inflamma- 
tion of  the  spinal  cord  is  consecutive  either  to  disease  or 
thickening  of  the  meninges  or  extensive  laceration  of  the  coid 
itself,  and  extends  transversely  across  the  spinal  cord,  we  then 
find  total  abolition  of  motion  and  sensation  ;  paralysis  as  well  of 
the  bladder  and  bowels,  and  disappearance  of  reflex  excitibaUty. 

Spinal  Concussion. — 8.  Concussion  of  the  spinal  cord  if 
at  all  serious  is  apt  to  be  followed  by  symptoms  which 
develop  very  quickly,  and  in  consequence  we  find  back  pain 
referred  to  the  dorsal  or  lumbar  region,  the  back  of  the  legs  or 
thighs  ;  a  want  of  power,  an  atony  of  the  bladder  and  rectum, 
and  various  ocular  symptoms.  There  is  rigidity  of  the  back 
and  the  slightest  movement  causes   intolerable  pain,  and  ordi- 


SPINAL  INJURIES.  353 

nary  walking  causes  great  suffering.  If  the  patient  be  told 
to  jump  he  will  complain  of  increased  pain,  caused  by  the  jar, 
and  he  suffers  after  the  slightest  motion.  The  loss  of 
power  is  extremely  variable  and  may  vary  from  simple  weak- 
ness to  complete  paraplegia,  and  electrical  reaction  of  the  mus- 
cles is  abased  or  lost. 

Erb'S  Classification. — Erb*  makes  the  following  divisions 
regarding  the  appearance  of  symptoms  : 

"  A.  General  and  very  severe  symptoms  at  the  instant  of 
injury.  Death  in  a  short  time.  Severe  form  of  shock." 
(Immediate  complete  paralysis.  Disturbance  of  consciousness, 
involuntary  discharges,  depression  of  pulse,  and  arrested  respi- 
ration. Speedy  death  in  a  few  days.  Usually  from  crushing 
or  other  severe  injuries.) 

"..5,  Severe  symptoms  at  the  moment  of  receiving  the  injury. 
^Cure  in  a  short  time.  Slight  shock.''  (No  loss  of  consciousness, 
usually  paraplegia,  pains,  anesthesia,  increased  reflexes,  rapid 
inprovement  in  a  few  days  and  speedy  recovery.) 

"C.  Severe  sy??iptoms  at  the  first,  followed  by  a  protracted 
illness  of  some  years'  duration  ;  recovery  in  most  cases."  (Shortly 
after  accident  progressive  paralysis  following  weakness  of  all 
extremities,  pain  in  back,  girdle  band,  light  anesthesia,  mental 
disturbance,  vomiting.     Slow  and  gradual  improvement.) 

**  D.  Very  slight  symptoms  at  the  beginning  ;  a  severe  progres- 
sive spinal  disease  develops  after  a  longer  or  shorter  time.  Resiclt 
doubtful."  (Primary  nervous  disturbances  of  a  light  grade, 
weakness,  mental  confusion.  After  a  short  time  severe  symp- 
toms develop.  Emotional  depression,  bad  sleep,  weakness 
and  ataxia  of  legs,  pain  and  paresthesia,  weakness  of  bladder, 
atrophy,  with  pronounced  meningo-myelitis.)  " 

The  above  are  the  varieties  collected  by  Erb,  and  the  symp- 
toms are  familiar  and  well  marked.  He  is  disposed  to  take  a 
rather  favorable  view,  except  in  those  cases  in  which  bed  sores 
and  other  serious  evidences  of  cord  disintegration  are  expressed. 


Case  LIX. — A  gentleman  sent  to  me  recently  by  Dr.  How- 
ard of  Montreal,  presented  grave  symptoms  of  speedy  develop- 
ment as  the  result  of  an  apparently  trifling  spinal  concussion 
which  seemed  almost  out  of  proportion  to  the  injury.  The  Rev, 
Dr.,  L.,  a  heavy  man  weighing  212  pounds,  while  walking  upon  a 
wooden  sidewalk  caught  his  toes  in  a  hole  and  fell  somewhat  vio- 

*  Ziemssen's  Cyclopedia,  vol.  xiii  p.  350,  Am.  translation. 


354  MEDICAL  JURISPRUDENCE. 

lently.  This  was  about  eighteen  months  ago  and  since  that  time  to 
the  present  (Jan.  1883),  a  train  of  very  serious  expressions  indic- 
ative of  resulting  organic  disease,  have  made  their  appearance. 
He  did  not  lose  consciousness  after  the  fall  but  felt  dizzy  and 
sick  for  ten  minutes  or  so,  and  beyond  a  slight  bruise  of  the 
left  hand,  which  he  had  thrown  out  to  save  himself,  he  suffered 
but  little  inconvenience.  About  three  weeks  after  the  accident, 
however,  he  began  to  feel  cramps  in  his  left  hand,  the  fingers 
becoming  rigid,  as  well  as  great  pain  in  the  back  especially  in 
the  lumbar  region,  but  subsequently  it  extended  upwards. 
.This  was  associated  with  paroxysms  of  intercostal  neuralgia 
with  attacks  of  coughing  and  besoin  de  respirer,  which  at  times 
amounted  to  distressing  dyspnoea.  When  I  first  saw  him  in 
January  there  was  some  loss  of  power  in  both  lower  extremities 
especially  the  left,  and  he  walked  with  difficulty.  There  was 
no  anesthesia  but  paresthesia  upon  the  line  of  the  last  dorsal 
vertebra,  the  legs  were  generally  atrophied  and  his  gait  was 
characterized  by  ataxia,  rather  more  marked  on  the  right  than 
the  left  side.  His  superior  extremities  were  involved  and  the 
left  hand  and  arm  are  especially  weak  and  it  causes  him  great 
distress  and  pain  to  raise  them  ;  he  can  not  button  his  clothing 
nor  use  his  hands  in  the  execution  of  delicate  acts.  There  is 
no  lost  sense  of  localization,  the  tendon  reflex  seems  to  be 
unaffected.  Galvanic  and  Faradic  action  are  disturbed  and 
but  few  of  the  muscles  of  the  upper  extremities  respond  to 
stimulation.  His  breathing  is  very  shallow  and  rapid,  and  his 
voice  is  dry  and  husky  and  it  is  an  effort  for  him  to  talk.  No 
evidences  of  disease  were  found  on  examination  of  the  heart 
and  lungs,  and  the  pelvic  organs  are  affected  to  a  slight  degree  ; 
he  is  troubled  with  tympanites.  There  are  so  far  no  cerebral 
symptoms  and  no  morbid  ophthalmoscopic  appearances.  Intel- 
lectually he  has  not  suffered,  but  he  tires  easily  and  can  not 
apply  himself  to  his  work. 

Trophic  Changes  after  Spinal  Concussion.— Trophic 
changes  are  apt  to  be  presented,  which  are  rare  however,  but  of 
great  interest. 

Case  LX. — A  patient  recently  placed  himself  under  treatment 
for  the  relief  of  nervous  sufferings  following  an  accident  in  1879. 
He  was  thrown  from  a  wagon,  striking  upon  his  left  side  and  cut- 
ting and  bruising  the  leg  and  thigh  of  that  side  and  wrenching 
the  right  leg,  and  back.  According  to  his  statement  he  was 
not  at  first  insensible  but  fainted  and  remained  unconscious 
for  a  few  minutes  ;  his  injuries  were  comparatively  trivial  and 


SPINAL  INJURIES.  355 

he  resumed  his  duties  in  his  regiment  in  two  or  three  days,  do- 
ing Hght  work.  Within  a  short  time  he  became  nervous  and 
unable  to  sleep  as  he  had  before  the  accident,  and  was  obliged 
to  come  East.  Since  July,  1879,  he  has  suffered  from  various 
symptoms  following  concussion  such  as  pain  through  the  lower 
part  of  the  spine,  over  the  first  and  second  lumbar  vertebrge 
which  sometimes  extends  upwards  or  about  the  body;  he  has 
in  addition  dull  pain  at  the  back  of  the  head  but  no  vertical 
pain,  and  none  in  the  arms  ;  he  has  sciatica  from  time  to  time  as 
well  as  pain  in  the  ankles,  more  especially  the  left.  It  is  im- 
possible for  him  to  get  a  comfortable  position  and  he  sits  on 
one  side  of  the  chair.  He  cannot  rise  from  his  chair  without 
great  difficulty  and  there  seems  to  be  not  only  aggravation  of  the 
spinal  pain  but  some  loss  of  power  as  well.  There  is  difficulty  in 
going  up  stairs,  and  he  usually  does  so  laterally,  the  right  leg  being 
put  in  advance  of  the  left.  He  limps  slightly  with  the  left  leg, 
which  is  decidedly  weaker  than  the  right,  and  wlien  tested  the 
electrical  reaction  is  diminished  but  there  is  no  atrophy.  The 
left  tendon  reflex  is  absent  and  the  right  is  exaggerated.  He 
co-ordinates  well  and  can  stand  with  his  eyes  closed.  He  can 
not  turn  over  in  bed  without  first  sitting  up  and  he  has  very 
great  difficulty  in  arising  from  the  recumbent  posture.  There 
is  some  incontinence  of  urine  proceeding  from  atony  of  the 
bladder,  and  this  fluid  is  loaded  with  lithates.  There  is  consti- 
pation. He  has  had  vertigo  and  blurring  of  vision  but  no  ocu- 
lar changes  are  to  be  discovered.  His  speech  is  somewhat 
affected,  there  being  a  clumsiness  as  well  as  actual  transposi- 
tion of  words.  By  far  the  most  interesting  feature  of  the  case 
is  the  manifestation  of  trophic  changes.  The  skin  was  white 
and  soft  before  the  accident ;  within  a  year  a  peculiar  bronz- 
ing and  mottling  appeared  about  the  ankles,  which  were  covered 
with  freckles,  there  being  more  perhaps  on  the  left  side  than 
the  right,  and  there  is  some  swelling. 

This  patient  has  received  very  little  benefit  from  treatment 
of  any  kind,  and  it  is  very  probable  that  he  has  a  serious 
organic  change  of  both  brain  and  spinal  cord  ;  his  recovery 
is  very  doubtful. 

Fatal  Cases  of  Spinal  Concussion.— The  two  following 
cases  reported  by  Wilks  are  examples  of  the  same  form  of 
spinal  concussion  and  in  both  instances  the  patient  died  : 

"  Joseph  P — ,  set.  32.  He  was  a  railway  porter,  and  whilst 
engaged  in  pushing  a  railway  truck  along  the  line,  he  suddenly 
came  to  an  ash-pit,  when,  for  fear  of  falling,  he  made  a  jump 


JJty  MEDICAL  JURISPRUDENCE, 

into  it,  and  ricked  his  head.  He  seemed  for  a  moment  to  be 
powerless,  but  soon  resumed  his  work.  On  the  following  day 
he  continued  also  his  work  as  usual.  On  the  third  day,  whilst 
walking  along  the  Borough,  he  suddenly  fell  in  the  street,  and 
was  unable  to  rise,  owing  to  the  weakness  of  his  legs  ;  this  in- 
creased during  the  next  two  days,  when  he  was  brought  to  the 
hospital.  He  was  then  completely  paraplegic,  had  no  power 
over  his  bladder  and  bed  sores  were  already  appearing.  Sub- 
sequently the  chest  became  affected,  and  he  died  in  six  weeks 
after  the  accident.  The  spinal  cord  appeared  quite  healthy  to 
the  naked  eye.  When  examined  by  the  microscope,  some  fatty 
granules  were  found  in  parts,  but  the  change  from  the  normal 
appeared  very  slight." 

"Wm.  A — ,  set.  21.  He  fell  on  his  back  more  than  a  year 
before  his  death,  and  then  had  symptoms  referable  to  concus- 
sion of  the  spine.  He  gradually  recovered  and  resumed  his 
work,  when  symptoms  of  paraplegia  slowly  came  on.  These 
gradually  increased,  so  that  for  about  four  months  before  his 
death  his  legs  were  completely  paralyzed  ;  then  his  arms  be- 
came affected,  and  subsequently  his  eyesight.  The  intellect 
quite  clear.  After  his  death,  when  the  the  cord  was  removed, 
it  appeared  at  first  healthy  as  regards  its  general  look  and  its 
firmness.  A  section,  however,  showed  the  presence  of  disease 
extending  its  whole  length,  and  passing  through  the  pons  to 
the  corpus  striatum.  There  was  no  disintegration  or  soften- 
ing, but  a  remarkable  change  had  occurred  from  the  presence 
of  a  translucent  albuminous  material  within  its  substance.  This 
was  for  the  most  part  situated  toward  the  surface  of  the  cord, 
so  that  a  section  showed  its  circumference  converted  into  a 
gray  translucent  material.  The  contrast  between  the  original 
white  medullary  matter  within  and  the  adventitious  substance 
around  it  was  very  great.  In  some  places  the  latter  had  pene- 
trated more  deeply,  so  as  to  involve  the  gray  matter  of  the 
cord.  The  pons  varolii  had  on  its  surface  two  or  three  patches 
of  the  same  material,  and  passing  into  the  substance  to  the  ex- 
tent of  about  one-eighth  of  an  inch,  and  on  the  corpora  striata 
and  thalami  optici,  especially  the  former  ;  there  were  some 
similar  patches  of  translucent  matter  on  the  surface.  These 
did  not  penetrate  deeply,  and  were  not  observable  in  the  in- 
terior. In  this  case  death  was  due  immediately  to  suppurative 
nephritis," 

Leyden  presents  a  case*  of  which  mention   may  be   made, 

*  Arcliiv.  filr  Psychiabie,  etc.viii.,  1878,  page  31.,  and  Boston  Med.  and 
Surgical  journal  Ang.  22,  1878. 


SPINAL   INJURIES.  357 

Its  interest  lies  in  the  fact  that  the  patient  presented  con- 
cussion symptoms  followed  by  acute  myelitis  and  pachymen- 
ingitis which  proved  fatal. 

"The  patient,  ahealthy  man  of  forty  years,  was  severely  bruis- 
ed, in  1873,  by  being  shaken  about  in  a  railway  carriage,  which 
had  slipped  off  the  track,  and  was  dragged  along  by  the  engine 
for  a  short  distance.  His  principal  symptoms  from  that  time 
onward  were  pain  in  the  left  shoulder,  and  paresis  of  the  left 
arm,  both  of  which  continued  until  his  death,  though  not  to 
the  same  degree  as  at  first  ;  occasional  attacks  of  pain  in  the 
sacral  region,  and  in  the  back  of  the  neck,  and  between  the 
shoulders  ;  "girdle-sensation  ;"  until  finally,  in  January,  1876, 
he  had  a  sudden  attack  of  acute  myelitis,  which  proved  fatal. 
The  diagnosis  made  was  myelitis  due  to  pressure  of  a  tumor  in 
the  lower  part  of  the  cervical  enlergement  of  the  cord.  The 
autopsy  confirmed  the  diagnosis,  showing  the  tumor  to  be  the 
result  of  chronic  peripachymeningitis." 

Locomotor  Ataxia  as  the  Result  of  Spinal  Concus- 
sion.— *Petit  alludes  to  locomotor  ataxia  that  may  be  caused 
by  traumatism,  and  details  among  others  the  case  of  a  man 
who  received  a  kick  from  a  horse.  He  was  unconscious  for  some 
hours,  but  no  immediate  bad  symptoms  followed.  A  year  later 
he  began  to  suffer  from  cramps,  pains,  and  tingling  in  the  legs, 
and  afterwards  from  incontinence.  I  have  seen  several  cases 
which  were  quite  decided  in  their  expression,  and  in  each  instance 
some  serious  shock  or  blow  was  described.  In  one  case  the 
patient  fell  from  an  open  window  and  the  sensory  symptoms  made 
their  appearance  within  a  few  weeks,  and  afterwards  there  was 
ataxia,  disappearance  of  the  patellar  reflex  and  ocular  troubles. 

Gowers  f  refers  to  the  possibility  of  a  general  myelitis  resolv- 
ing itself  into  a  localized  degeneration  of  the  posterior 
columns. 

Postero-Lateral  Sclerosis. — Dr.  Edes  has  published  four 

cases  which  illustrate  the  frequent  occurrence  of  degeneration 
of  the  postero-lateral  columns  01  the  cord  as  a  result  of  spinal 
concussion.  He  noticed  in  these  cases  a  very  decided  increase 
in  the  tendon  reflex,  ankle  clonus,  as  well  as  contractions  and 
other  troubles.     One  of  his  cases  is  that  produced  : 

"  T.  D.,  laborer,  fell  down-stairs  eight  days  before  his  en- 

*  Revue  Mensuelle,  tome  iii. ,  1879,  P-  209. 
\  Br.  Med.  Journal,  vol.  i.,  1879, p.  304. 


35^  MEDICAL   JURISPRUDENCE. 

trance  into  the  hospital,  and  thinks  he  struck  on  his  head,  but 
has  no  bruise  anywhere.  Immediately  after  the  fall  he  lost 
the  use  of  both  arms  and  hands.  He  can  now  move  his  right 
elbow  a  little.  His  legs  are  rather  weak,  so  that  he  staggers  on 
attempting  to  walk.  There  has  been  twitching  of  both  legs  for 
the  last  two  days.  The  next  day  after  entrance  he  did  not 
sleep  well.  He  complained  of  pain  darting  down  the  arms, 
which,  he  says,  began  immediately  after  the  accident.  The 
muscles  react  well  to  the  faradic  current.  The  paralysis  dis- 
appeared rapidly  and  almost  completely,  and  it  was  after  his 
officiation  for  some  time  as  a  volunteer  nurse,  and  about  two 
months  after  the  accident,  that  it  was  found  that  the  tendon 
reflexes  of  the  upper  extremities  were  greatly  exaggerated, 
moderate  taps  upon  the  tendons  of  the  biceps,  triceps,  supina- 
tor longus,  deltoid,  pectorales,  and  even  the  sterno-mastoids 
exciting  decided,  and  in  some  instances,  very  active  responses. 
Patellar  tendon  reflex  somewhat  increased;  no  ankle  clonus. 
He  was  discharged  relieved." 

The  Possible  Complication  with  Lead  Parnlvsis.— 

In  certain  injury  cases  the  defense  may  be  presented  that 
the  patient's  symptoms  are  in  reality  due  to  lead  poisoning, 
the  result  of  his  trade — and  in  such  a  case  I  appeared  some 
years  ago.  In  apposition  to  my  case  is  that  reported  by  Dr. 
Edes  *  in  which  the  symptoms  were  largely  complicated  by 
those  of  lead  poisoning.  In  this  case,  however,  the  major 
sym[)toms  were  due  to  the  accident. 

"  D.  H.,  aged  twenty-six,  lead-worker,  fell  backward  down- 
stairs while  drunk.  When  admitted  to  the  hospital  the  next 
day  had  cellulitis  of  the  right  leg,  and  various  bruises  on  both 
legs.  Four  days  after  he  was  unable  to  move  the  right  leg,  and 
tliere  was  incontinence  of  urine.  Two  days  later  the  left  leg 
would  not  move.  He  had  lost  more  or  less  strength  in  his 
hands.  Two  months  afterwards  it  was  noted  that  the  legs 
"draw  up"  at  night,  and  he  has  difficulty  in  straightening 
them.  He  has  imin  in  the  back  of  the  neck  and  between 
shoulders.  There  was  considerable  muscular  atrophy  in  the 
left  hand,  less  in  the  right.  Reflex  and  tendon  reflex  about 
normal.  Ten  days  later  the  ankle  clonus  was  very  well  marked. 
The  patellar  reflex  was  attended  with  several  vibrations. 
There  was  no  (slight  ?)  olecranon  tendon  reflex.  From  this 
time  his  condition  continued  about  the  same,  although  he  him- 
self thought  he  improved.     Attemj)ts  at  voluntary  movement 

*  Boston  Med.  S?'  Surg.  Journal,  Sept.  21,  1882,  p.  265. 


SPINAL   INJURIES.  359 

were  attended  with  strong  spasmodic  movements  in  both  legs, 
which  could  easily  be  excited  also  by  the  usual  procedure  for 
obtaining  ankle  clonus. 

"  He  was  discharged  from  the  hospital  not  relieved.  In  this 
case  the  posterolateral  degeneration  may  perhaps  have  been 
secondary  to  some  more  limited  injury  at  first,  say,  for  instance, 
small  hemorrhages. 

"  This  man  had  a  lead  line  on  his  gums,  and  lead  was  at  one 
time  found  in  his  urine.  This  point  is  interesting  in  connec- 
tion with  a  possible  affection  of  the  anterior  horns  and  the 
atrophy  of  the  muscles  of  the  hands  noted  early  in  the  case." 


Case  LXI. — A  man  while  sitting  in  a  street  car  received  a 
severe  spinal  injury  by  reason  of  a  collision  with  a  heavy 
wagon.  The  pole  of  the  wagon  was  forced  through  the  back 
of  the  seat,  striking  him  squarely  in  the  middle  of  the  back.  He 
subsequently  developed  a  meningo-myelitis  with  great  pain, 
irregular  paraplepia  and  atrophy  of  the  muscles  of  the  lower 
extremities.  When  he  sued  for  damages,  evidence  was  brought 
forward  to  show  that  his  occupation  had  been  that  of  a  painter. 
He  had  not  worked  at  his  trade  for  a  long  time  before  the  trial 
yet  one  of  the  witnesses  thought  he  discovered  a  lead  line.  I 
could  not  find  any  such  change,  but  did  find  that  his  teeth  were 
carious,  and  that  he  did  not  clean  them,  and  the  result  was 
a  spongy  condition  of  the  gums.  His  motor  symptoms  and 
atrophy  were  confined  to  the  lower  extremities,  a  very  uncom- 
mon situation  in  lead  disease,  and  there  was  no  anesthesia.  His 
reflexes  were  exaggerated,  and  his  upper  extremities  were 
involved.  I  subsequently  learned  that  though  he  did  not 
work  at  his  trade  after  the  trial,  the  symptoms  advanced. 
The  verdict  was  rendered  for  the  plaintiff. 

Suits  for  Damages. — Suits  for  damages  instituted  by 
persons  who  have  been  injured  in  railway  accidents  have 
during  the  past  twenty  years  been  exceedingly  common,  and 
often  of  great  interest.  Much  of  this  arises  from  the  express- 
sion  in  many  cases  of  symptoms  indicative  of  disease  of  the 
nervous  system  of  a  very  peculiar  nature,  first  recognized  and 
described  by  Mr.  John  Eric  Erichsen,  a  distinguished  London 
surgeon.  Mr.  Erichsen's  book  has  figured  in  many  of  the  law- 
suits that  have  since  been  brought  both  in  England  and  this 
country,  and  at  least,  (putting  it  at  a  low  figure,)  twenty  millions 
of  dollars  have  been  paid  to  persons  claiming  to  have  received 
spinal  concussions  since  its  appearance.     In  this  country  the 


360  MEDICAL   JURISPRUDENCE. 

wrecking  of  an  excursion  train  on  one  of  the  New  England 
Railroads — the  Revere  disaster — entailed  a  loss  to  the  Eastern 
P.ailroad  in  judgments,  settlements,  and  legal  ex])enses  of  half 
a  million  of  dollars,  and  another  accident  cost  the  Old  Colony 
Railroad  $395,000. 

In  similar  cases  immense  sums  of  money  have  been  paid  by 
sympathetic  juries.  In  England  the  sum  of  ^16,000  was 
awarded  to  one  claimant,  while  in  this  country  to  Harold  the 
sum  of  $30,000  was  allowed  by  a  Brooklyn  jury. 

The  very  nature  of  the  irregular  group  of  symptoms 
encourages  fraud  and  rascality.  Dr.  Hodges  in  two  ad- 
mirable papers  calls  attention  to  the  fact  that  in  "  twenty- 
one  cases  where  the  so-called  symptoms  of  concussion  of  the 
spinal  cord  were  alleged  to  be  present,  which  have  been  under 
my  personal  care,  ten  are  believed  to  have  been  deceptions, 
and  in  six  the  diagnosis,  as  regards  deception  was  doubtful. 
Of  26  similar  cases  observed  by  Rigler,  seven  were  found  who 
simulated,  and  in  13  the  diagnosis  in  regard  to  fraud  was 
doubtful.  Of  49  cases,  therefore,  it  would  appear  that  36  or 
three-fourths  of  the  whole  number  were  really  or  probably 
deceptions." 

In  my  own  experience  the  proportion  has  been  equally  great. 
The  fact  remains  that  after  sudden  and  violent  shock  to  the 
human  body,  even  though  there  may  be  no  apparent  external 
marks  or  wounds  a  train  of  symptoms,  indicative  of  profound 
functional  disturbance  may  remain  for  a  variable  time,  and 
may  be  followed  by  unmistakable  organic  disease  of  the  spinal 
cord  or  brain. 

The  peculiar  transmission  of  a  concussion  is  very  often 
somewhat  remarkable.  So  far  as  is  known,  the  disease  known 
as  railway  spine,  does  not  follow  the  hurling  of  a  passenger 
against  the  seat  or  woodwork  of  a  car,  so  much  as  it  does  the 
undefinable  molecular  change  which  is  supposed  to  occur 
when  the  car  in  which  the  person  is  sitting  is  suddenly  stopped 
when  under  way  and  going  at  the  rate  of  from  20-40  miles  an 
hour. 

Einbranlement. — What  the  French  call  embranleninii 
immediately  follows  the  complete  arrest  of  motion. 

It  may  ha])pen,  however,  from  the  transmitted  force  of  a 
collision  with  another  train  which  may  run  into  one  stationary, 
that  a  person  sitting  near  the  end  of  the  stationary  train  furthest 

*  Hodges  Boston  Medical  and  Surgical  yournal,  Ap.  28,  1881. 


SPINAL   INJURIES.  36 1 

removed  from  the  point  of  collision,  suffers  a  spinal  concussion 
sufficient  to  give  rise  to  spinal  injury. 

A  gentleman  I  saw  who  was  injured  in  the  H,  R.  R.  R.  acci- 
dent, at  Spuyten  Duyvel,  sat  in  the  smoking  car,  the  eighth  car 
from  the  end,  yet  when  the  collision  occurred  he  was  thrown 
forward  against  the  seat  before  him  and  then  backward,  receiv- 
ing a  spinal  shock  sufficient  to  give  rise  to  objective  as  well 
as  subjective  symptoms.  This,  however,  is  not  often  the  case 
nor  is  it  when  the  person  is  asleep  as  was  my  patient.  Much 
damage  may  occur  from  an  apparently  trifling  accident.  Mr. 
Charles  Francis  Adams.  Jr.,  relates  the  circumstance  of  three 
gentlemen  leaving  a  rear  car  of  a  train  which  had  run  into  an- 
other, and  going  to  their  homes  in  perfect  ignorance  of  the 
accident  at  the  time,  while  in  the  front  cars  there  was  great 
loss  of  life. 

The  immediate  nervous  effects  are  often  violent.  I  saw 
some  time  after  an  accident  a  strong  man  who  had  escaped 
from  a  wrecked  car.  Though  an  hour  had  elapsed,  his  nerv- 
ous prostration  was  great,  his  hands  and  feet  were  icy  cold  ; 
his  whole  body  was  agitated  by  tremor,  and  respiration  and 
circulation  were  very  much  disturbed. 

Lighter  Forms. — An  interesting  case  of  the  lighter  form 
of  spinal  concussion  is  related  by  Bernhardt*. — "  A  stout, 
healthy  man  received  a  violent  concussion  in  a  railway-acci- 
dent, remaining  senseless  for  some  time,  and  being  confined 
to  his  bed  for  three  weeks  with  scalp-wounds,  etc.  When  he 
was  able  to  get  about,  he  complained  of  general  loss  of  strength, 
and  of  weak  vision  ;  during  the  first  few  weeks,  of  double 
vision.  Examination  at  this  time  showed  him  to  be  in  good 
general  condition.  He  complained  of  headache,  especially  in 
the  region  of  a  scar  some  two  inches  in  length  over  the  left 
parietal  bone.  He  was  not  particularly  sensitive  to  blows  on 
the  head.  He  was  more  easily  disturbed  and  depressed  in 
spirits  than  previously.  He  was  exceedingly  sensitive  to  heat, 
which  made  him  giddy  and  caused  a  throbbing  in  the  scar.  He 
could  not  bear  the  noise  of  wagons  etc.,  and  was  unable  to  ride 
in  any  conveyance.  Stooping  or  looking  up  or  suddenly  to 
one  side  made  him  giddy.  He  could  read,  but  only  for  a 'short 
time,  as  the  letters  soon  began  to  swim  before  his  eyes.  The 
pupils  were  similar  and  reacted  to  light,  which  was  unbearable 
if  bright.     The  movements  of  the  ball  were  perfect.  No  change 

*  Berliner  Klin.     Wochcnschrift,     1876,    p.    275   Augus-t  g.     Abstract  in 
Phila.  Med.  Times,   1876. 


362  MEDICAL    JURISPRUDENCE. 

visible  with  the  ophthalmoscope.  Hearing  good  ;  no  buzzing  in 
the  ear.  Taste  and  smell  normal.  Nothing  abnormal  in  the 
region  of  the  remaining  cranial  nerves,  nor  in  that  of  the  facial, 
trigeminal,  or  hypoglossal.  Pressure  over  the  spinous  processes 
of  the  vertebrae  is  only  painful  towards  the  lower  part  of  the 
neck.  Subjectively,  a  feeling  of  tension  was  experienced  in 
the  loins  ;  rising  and  sitting  down  could  be  accomplished  with 
difficulty.  Movements  in  the  upper  extremities  were  free,  but 
there  was  a  loss  of  motor  power  ;  the  outstretched  fingers 
trembled  ;  it  took  him  a  whole  day  to  write  a  letter,  the  fingers 
trembled  so  when  used.  The  patient  could  stand  with  the 
feet  together,  even  when  the  eyes  were  shut,  and  could  also 
walk,  but  slowly  and  with  careful  steps.  The  left  leg  was 
slightly  dragged.  He  could  only  stand  a  short  time  on  either 
leg  alone.  All  movements  could  be  performed  with  the  limbs, 
but  a  very  little  hindrance  sufficed  to  stop  them.  The  left 
seemed  to  have  less  power  than  the  right.  No  disturbance  of 
sensibility.  The  patient  was  aware  of  even  slight  movements, 
and  localized  correctly.  He  could  perceive,  if  his  bare  feet 
touched  the  ground,  what  the  nature  of  this  was.  His  urine  was 
normal,  and  passed  without  difficulty  by  a  little  extra  exertion. 
He  could  only  retain  his  stools  (otherwise  normal)  for  a  very 
short  time.  In  a  somewhat  similar  case  which  came  under  Dr. 
B.'s  notice,  no  symptoms  of  brain-trouble  were  observed  for  a 
veek  subsequent  to  the  accident.  This  patient  suffered  greatly 
from  hyperesthesia.  In  commenting  upon  these  cases,  Dr. 
Bernhardt  alludes  to  the  difficulty  of  making  an  exact  diag- 
nosis regarding  the  portion  of  the  brain  most  affected.  He  also 
suggests  the  treatment  advisable,  and  points  out  the  importance, 
from  a  legal  point  of  view,  of  the  fact  that  one  of  the  patients 
went  about  his  ordinary  occupations  for  a  week  subsequent  to 
the  railway-accident  before  any  brain-symptoms  developed 
themselves." 

Pulse  Changes. — The  pulse  of  spinal  concussion  is  of- 
ten changed  in  character  and  becomes  weak,  irregular  and 
greatly  excited.  I  saw  a  patient  with  Dr.  Charles  E.  Lock- 
wood  of  this  city,  who  presented  a  remarkable  change  in  this 
respect. 

Case  LXII.—  ~ 

•  Dr.  Lockwood  furnishes  us  with  the  following  report    from 

his  history-book. — "On  December  i,  1881,  I  was  called  to  see 

Mr.  W.  W.  R.,  who  gave  the  following  history: — While  traveling 

from  Washington  to  New  York  on  a  train  on  the  Pennsylvania 


SPINAL   INJURIES.  363 

railroad  on  the  morning  of  Nov.  30,  1881,  he  had  occasion  to 
enter  the  water-closet  of  the  car  in  which  he  was,  and  while 
there  in  a  standing  position,  adjusting  his  clothes,  a  collision 
occurred  between  the  train  on  which  he  was  and  one  following. 
He  stated  that  he  was  first  thrown  forward,  then  backward,  and 
then  forward  again,  his  abdomen  striking  upon  the  upturned 
edge  of  the  cover  of  the  seat  of  the  water-closet,  which,  having 
been  raised  was  in  a  position  perpendicular  to  the  horizontal 
plane  of  the  seat;  he  stated  that  he  vomited  blood  mixed  with 
bile  for  about  two  hours,  suffered  much  from  pain,  faintness, 
and  was  bathed  in  a  cold  perspiration  which  saturated  his  un- 
derwear. When  he  reached  Jersey  City  he  was  seen  by  Dr, 
Watson  who  prescribed  for  him.  He  then  came  over  to  New 
York  feeling  a  craving  appetite,  ate  some  solid  food  which  he 
vomited  soon  after,  and  then  took  the  cars  to  his  board- 
ing-house, where  he  endeavored  to  write  some  letters  but  was 
compelled  to  go  to  bed  owing  to  pain  in  liis  back. 

"  When  I  saw  Mr.  R.  on  Dec.  i,  he  was  suffering  from  general 
hyperaesthesia  over  the  whole  body  but  especially  over  the  arms, 
legs,  abdomen  and  back,  severe  aching  pains  in  abdomen  and 
back,  and  he  was  unable  to  move  from  the  recumbent  position 
without  suffering  from  attacks  of  nausea  and  retching  ;  he  had 
passed  his.  urine  and  there  was  no  paralysis  or  loss  of  sensa- 
tion and  there  had  been  no  movement  from  the  bowels. — 
Pulse  72  in  a  minute,  and  axillary  temperature  98^°,  Mind 
clear  and  hopeful.  On  Dec.  2,  he  seemed  to  feel  dull  and 
weak.  Pulse,  66.  Temp,  in  axilla  97^,  Resp.  18. — Was  unable 
to  take  any  solid  food,  and  even  milk  and  lime  water  in  small 
quantities  brought  on  attacks  of  retching  ;  passed  his  urine 
only  once  in  24  hours  ;  quantity,  about  8  oz.  Spoke  of  having 
slight  cramping  in  his  toes,  as  though  one  were  crossed  over  the 
other  ;  urine  examined  chemically  and  microscopically  and 
no  evidence  of  kidney  disease  found  ;  specific  gravity,  1020, 
acid,  no  albumen  or  casts.  Matters  continued  about  as  de- 
scribed until  Dec.  6,  when  the  pulse  was  about  76  and  inter- 
mitted three  times  in  a  minute  and  he  complained  of  feeling 
slight  tingling  in  the  ends  of  fingers.  Suspecting  trouble 
of  spinal  cord  I  asked  Dr.  Walter  H.  Gillette  to  see  him  in 
consultation  on  Dec.  7,  when  a  diagnosis  was  made  of  con- 
cussion of  the  spinal  cord.  I  saw  Mr.  Randall  twice  daily 
from  Dec.  2  to  Dec.  19,  1881  and  once  daily  with  one 
exception  from  last  mentioned  date  to  Jan.  11,  1882  ;  during 
that  time  his  symptoms  have  been  generally  as  follows: 
bowels  sluggish  and  not  inclined  to  move  except  after  medi- 


364  MEDICAL   JURISPRUDENCE. 

cine,  urine  passed  with  some  hesitation  and  difficulty  and  at 
infrequent  intervals,  sometimes  only  once  in  36  hours  ;  skin  of 
hands  dry  and  whitish-looking,  showing  malnutrition,  prickling 
of  ends  of  fingers,  a  continual  "  buzzing  sensation  "  as  he  ex- 
presses it,  in  the  fingers  and  toes,  but  which  he  has  become  so 
accustomed  to  that  he  does  not  notice  unless  spoken  to  about 
it  ;  twitchings  of  muscles  of  calves  of  legs,  especially  right  leg  ; 
burning  aching  sensation  in  the  back,  especially  that  portion 
between  shoulder-blades  and  over  lumbar  region  ;  low  tempera- 
ture from  Dec.  2  to  Dec.  11,  ranging  at  about  97 1  in  axilla  and 
on  Dec.  11  and  Dec.  15,  being  about  gS}4  in  the  rectum,  not 
having  been  taken  in  rectum  on  other  dates.  Pulse  intermittent, 
sometimes  there  being  as  many  as  ten  intermissions  in  a  minute; 
the  intermissions  were  noticed  first  on  Dec.  6,  and  continued  un- 
til Dec.  II,  there  having  been  none  from  Dec.  i  to  Dec.  6;  from 
Dec.  II  to  Dec.  29,  pulse  was  regular,  since  which  time  it  has 
at  times  been  regular  and  again  intermittent  :  he  has  had  hal- 
lucinations and  has  been  somewhat  delirious  at  times,  especially 
in  waking  from  sleep  ;  his  memory  is  defective,  and  he  has 
complained  of  confusion  of  mind  and  inability  to  concentrate 
his  thoughts  ;  has  suffered  from  restlessness  and  inability  to 
sleep  at  night.  Dr.  Hamilton  saw  the  patient  with  me  on 
Dec.  24,  188 r  and  Jan.  9,  1882,  and  confirmed  the  diagnosis  of 
concussion  of  the  spinal  cord;  at  the  present  time  his  condition 
is  about  as  follows:  he  suffers  occasionally,  more  especially 
after  any  exertion,  from  twitching  of  posterior  muscles  of  legs, 
pain  in  the  back,  numbness  and  tingling  of  fingers  and  toes, 
stands  and  walks  with  difficulty,  being  liable  to  fall  unless  sup- 
ported, bowels  sluggish,  urine  passes  at  times  slowly  and  at 
times  more  freely.  Pulse  about  78  and  intermittent,  tempera- 
ture about  normal;  pupils  unequally  dilated,  tendon  reflex  in- 
creased in  both  legs." 

Ocular  Symptoms. — The  ocular  symptoms  following  spinal 
concussion  or  more  serious  spinal  injuries  are  exceedingly  in- 
teresting but  by  no  means  as  common  as  Erichsen  would  have 
us  believe.  It  was  Gowers*  who  first  called  attention  to  the 
serious  changes  that  may  exist  at  the  fundus  oculi  as  the  re- 
sult of  a  railroad  injury  ;  but  in  this  case  the  patient  received 
a  blow  upon  the  left  side  of  the  forehead  which  rendered  him 
insensible  for  five  minutes.  Pie  was  laid  up  three  weeks  and 
suffered  from  spinal  and  head  pain  and  general  nervous  dis- 
turbances.    Paige,  who  refers  to  the  case,  says  that  he  present- 

*  Medical  Ophthahiioscophy,  4.  ed.,  p.   348. 


SPINAL   INJURIES.  365 

ed  six  months  after  the  accident  loss  of  vision  in  the  left  eye 
to  a  great  degree,  limitation  of  the  field,  and  slight  changes  in 
the  optic  discs.  In  two  cases  I  have  detected  well-marked 
optic  neuritis  and  in  one  there  was  commencing  atrophy  in  both 
eyes,  with  Argyle-Robertson  pupils,  but  both  of  these  patients 
presented  organic  spinal  symptoms.  In  many  cases  we  find 
temporary  functional  disturbances  of  accommodation,  which, 
however,  need  not  be  viewed  with  any  seriousness.  Among 
these  are  patients  who  really  possess  slight  astlienopia  which 
may  be  due  to  the  general  condition  of  bodily  weakness, 
but  this  is  all.  Such  patients  are  unable  to  concentrate 
their  attention  when  reading,  and  such  an  effort  produces  head- 
ache. Sometimes  we  find  that  the  disturbance  is  entirely  due 
to  a  hypermetropia  which  is  a  congenital  condition,  and  is  in- 
creased by  the  patient's  nervous  exhaustion.  In  cases  of 
fraud  it  may  be  found  that  the  alleged  defect  is  due  to  cataract 
or  some  condition  entirely  foreign  to  the  case. 

Bogus  Cases. — In  contrast  to  the  cases  I  have  just  detailed, 
and  who,  strange  to  say,  made  no  attempt  to  bring  suit  or 
obtain  compensation,  are  those  which  are  familiar  to  every 
physician  who  has  occasion  to  examine  persons  who  present 
themselves  after  almost  every  railroad  accident  with  doleful 
stories  of  suffering  and  injury  which  are  far  more  often  im- 
aginary than  real.  I  have  seen  many  of  these  cases  at  the 
solicitation  of  the  railroad  companies,  and  have  repeatedly 
heard  the  same  story  of   deception. 

The  Effect  of  a  Verdict. — In  the  great  majority  of  cases 
a  good  verdict  brings  with  it  a  complete  cure,  and  patients  who 
have  been  brought  into  court  upon  a  litter  surrounded  by  tear- 
ful and  interested  friends  and  attentive  physicians,  whose  cases 
have  been  dramatically  described  to  the  jury,  leave  the  court 
room  and  a  few  days  or  weeks  after  the  swindle  engage  in  their 
regular  pursuits  as  if  nothing  had  happened.  It  is  to  be  re- 
gretted that  in  such  cases  physicians  have  been  found  who  have 
been  willing  to  testify  to  the  existence  of  serious  organic  dis- 
ease of  the  nervous  system  when  no  evidence  of  such  was  pre- 
sented except  the  patient's  unreliable  and  prejudiced  state- 
ments.    This  class  of  cases  is  divided  into  two  sub-divisions. 

Hypochondriasis  aud  Spinal  Concussion. — Those  who 
suffer  from  a  hysteria  or  hypochondriasis  which  in  one  way  is 
a  diseased  condition,  and  does  not  necessarily  carry  with  it 
intentional  dishonesty,  and  under  these  circumstances  a  fair 


366  MEDICAL   JURISPRUDENCE. 

verdict,  directed  rather  to  compensate  for  the  injury  of  mind, 
should  be  given. 

Fraudulent  Litigation. — Another  division  of  the  above 
may  be  made,  in  whose  ranks  are  to  be  found  a  variety  of 
impostors  as  motley  and  disreputable  as  Falstaff's  artny.  No 
one  but  the  medical  officer  of  a  railroad  can  conceive  of  the 
cunning  deviltry  which  enters  into  the  machinations  of  one  of 
these  disreputable  claimants  when  backed  up  by  an  equally  un- 
scrupulous attorney.  Careful  detective  espionage  will  reveal  the 
fact  that  this  paralytic  (?)  is  about  his  business  ;  that  he  is  con- 
sulting with  his  friends  at  the  porter  house  when  he  imagines  he 
is  not  under  observation  ;  and  that  perhaps  he  may  be  engaged 
in  such  amusements  as  horseback  riding,  base  ball  playing,  or 
the  like,  when  it  has  been  claimed  that  he  is  paralyzed,  or  that 
he  suffers  from  an  inflammation  of  the  spinal  cord  which  pre- 
vents him  from  moving  his  body  ! 

Instances  of  Deception. — In  one  of  these  cases,  that  of  a 
man  who  claimed  that  his  injuries  were  immediate,  and  that  he 
was  unconscious  at  the  time  of  the  collision,  it  transpired  sub- 
sequently that  he  not  only  loitered  about  the  wreck  but  that  he 
walked  home  and  attended  to  his  daily  pursuits  without  seem- 
ing discomfort.  In  another  case  the  individual  was  paid  a 
large  sum  of  money,  and  it  was  afterwards  proved  that  he  had 
not  been  upon  the  train  at  all. 

I  was  called  a  few  months  ago  to  examine  a  man  whose  com- 
plaints were  especially  heartrending  and  unfortunate,  but  whose 
bodily  condition  did  not  bear  out  his  story.  This  man's 
physicians  claimed  that  after  the  accident  he  had  developed  a 
degeneration  of  the  brain  and  spinal  cord,  but  on  good  author- 
ity I  learned  that  the  same  claim  had  been  made  by  him  sev- 
eral years  before  after  an  accident  on  another  road,  and  an 
equally  unfavorable  condition  of  affairs  was  alleged  to  exist. 


Case  LXIIL— 

One  of  the  most  audacious  instances  of  swindling  I  have 
ever  known  occurred  as  the  result  of  the  42d  street  accident 
upon  the  Elevated  Railroad.  A  young  girl  presented  her- 
self at  the  office  of  the  company,  presenting  beside  a  vague 
series  of  symptoms  suggestive  of  spinal  concussion,  a  peculiar 
depression  of  the  sternum  which  she  claimed  was  a  traumatic 
result  of  the  collision.  Upon  the  statement  of  her  physician, 
whom  she  had  deceived,  three  thousand  dollars  were  given  her, 


SPINAL   INJURIES.  367 

fifteen  hundred  of  which  were  deposited  in  the  bank  in  her  name 
and  the  balance  devoted  to  the  payment  of  doctors'  bills  and 
and  other  expenses.  It  was  found  within  a  year  that  the  girl 
had  not  been  upon  the  train  at  all,  that  the  depression  of  the 
sternum  had  been  made  by  an  instrument  like  a  brace  aud  bit, 
held  against  the  chest,  and  used  in  the  process  of  artificial 
flower-making,  a  trade  she  had  been  engaged  in  for  some  time, 
and  that  her  other  symptoms  were  pure  inventions.  Her  father, 
who  had  coached  her  in  her  role  of  deceit,  was  arrested,  con- 
victed and  is,  I  believe,  now  in  Sing  Sing. 

Exaggeration. — As  I  have  said,  the  mental  condition  of 
many  of  these  patients  is  purely  hysterical,  and  from  constant 
concentration  of  attention  upon  themselves  and  the  expectancy 
of  a  verdict,  a  state  of  real  suffering  is  produced  which  is  striking 
and  peculiar.  While  every  muscle  of  the  body  may  preserve 
its  integrity  of  function,  and  no  organ  suffers  pathological 
change,  we  find  an  emotional  derangement  which  cannot  be 
shammed,  and  there  is  a  depression  in  some  cases  amounting 
to  simple  melancholia.  With  a  few  suggestions  from  Mr.  Erich- 
sen's  book  and  a  knowledge  of  how  some  friend  was  affected  in 
another  accident,  a  patient  is  ever  ready  to  believe  in,  and  com- 
plain of  a  variety  of  aches  and  pains  which  are  purely  imaginary. 
By  the  statement  of  these  patients,  and  authors  who  have 
described  them,  it  is  found  that  "constant  pain  in  the  back," 
fatigue  of  the  muscles,  of  the  legs  especially,  headaches,  "inca- 
pacity for  mental  work,"  confusion  of  ideas,  "loss  of  memory 
and  weakened  vision"  are  characteristic  symptoms  of  spinal 
concussion. 

Hysteria  and  Spinal  Concussion. — The  unprejudiced 
physician  will  find,  if  he  believe  that  these  conditions  really  exist, 
that  there  are  as  well  many  other  symptoms  which  are  conspic- 
uous in  ansemic  and  hysterical  persons  who  perhaps  suffer  from 
pelvic  disorders,  but  depend  in  the  case  of  the  litigant  upon  ner- 
vous excitement  and  exhaustion  and  are  entirely  independent  of 
any  violent  influences.  Careful  questioning  may  determine  the 
existence  of  pain  and  tenderness  over  the  seventh  cervical  spine, 
of  ovarian  tenderness  ;  perhaps  of  digestive  disorder,  of  the 
globus  hystericus  in  some  cases  ;  and  of  pallor  and  other  well- 
known  manifestations  of  functional  nervous  disturbance. 

In  one  of  Page's  cases  the  claim  was  made  that  the  seventh 
cervical  vertebra  was  unduly  prominent,  and  the  result  of  an 
injury,  the  patient  having  received  a  bruise  upon  the  lower  part 
of  the  back.     Two  years  after  the  accident  she  was  perfectly 


368  MEDICAL  JURISPRUDENCE. 

well.  Not  only  may  the  person  who  is  so  eager  for  pecuniary 
balm  attempt  to  palm  off  long  existing  troubles  for  genuine  in- 
juries, but  he  may  invent  the  most  outrageous  and  improbable 
pretexts  for  pressing  his  suit.  With  such  patients  a  loss  of  pro- 
creating power,  or  pretended  injuries  to  the  organs  of  genera- 
tion are  often  claimed,  while  no  such  impairment  really  exists, 
and  the  matter  is  made  more  difficult  by  the  absolute  refusal  of 
the  patient  to  submit  to  any  examination  by  the  defendant's 
physicians,  and  in  this  she  receives  occasionally  the  support  of 
the  Court.  A  ridiculous  side  of  the  question  is  often  presented 
after  the  disposal  of  the  case,  and,  unfortunately,  after  a  sym- 
pathetic jury  have  given  a  sentimental  verdict.  In  one  case 
with  which  I  am  familiar,  it  was  claimed  that  the  shock  had 
produced  an  incurable  dislocation  of  the  uterus  and  that  the 
woman  would  never  again  bear  children,  a  few  months  how- 
ever, after  a  handsome  verdict,  she  became  a  mother.  It 
sometimes  happens  that  the  influence  of  uterine  disturbance 
will  greatly  increase  the  nervous  excitement  and  prejudice  the 
minds  not  only  of  experts  for  the  plaintiff  but  the  jury  as  well. 
In  a  woman,  the  subject  of  miscarriages,  this  question  arose. 
And  Dr.  Page,  who  reports  the  case,  stated  that  though  she  was 
pregnant  at  the  time  of  the  accident  the  labor  was  not  inter- 
fered with,  but  that  she  subsequently  had  several  miscarriages 
and  much  nervous  suffering,  which  she  believed  to  be  due  in 
great  part  to  the  exhaustion  attendant  upon  frequent  gestation. 
It  seems  that  the  jury  were  inclined  to  take  his  view  of  the 
case,  for  they  gave  her  but  one-sixth  of  the  amount  asked  for. 
Erichsen  is  disposed  to  take  a  grave  view  of  a  complication  of 
pregnancy,  not  so  much  in  regard  to  the  immediate  but  remote 
effects  of  the  concussion.  So  far  as  my  own  experience  is 
concerned,  I  have  found  little  to  warrar.t  the  belief  that  the 
functions  of  the  organs  of  generation  in  women  are  affected 
in  any  serious  way  by  a  trouble  of  this  kind.  This  is  true  also 
in  regard  to  the  other  sex,  although  claims  are  constantly  made 
in  the  courts  that  all  manner  of  disturbances  and  great  en- 
feeblement  follow  spinal  concussion.  In  cases  of  injury  to 
the  spinal  cord  attended  by  organic  involvement  above  the 
splanchnic  nerves  such  changes  may  follow,  but  these  are  very 
rare.  Care  should  be  taken  not  to  acce])t  the  statement  of  the 
patient  as  conclusive  that  vesical  irritability  or  incontinence 
are  due  to  nothing  else  than  the  injury,  for  in  many  of  these 
cases  there  may  have  been  yjreviously  existing  cystitis,  and  in  one 
I  examined  I  found  that  the  man  had  been  buying  and  using  a 
well  known  and  popular  specific  known  as  Belhesda  water  while 


SPINAL  INJURIES.  369 

in  other  cases  a  history  of  urethritis  with  its  attendant  conse- 
quences was  ascertained.  In  men  past  middle  age  it  may  be 
well  to  find  whether  or  not  there  is  an  enlarged  prostate. 

Insanity  and  Spinal  Concussion. — It  is  sometimes 
urged  that  patients  become  insane  as  the  result  of  spinal  inju- 
ries. While  I  am  perfectly  willing  to  admit  that  organic 
spinal  disease  may  by  extension  produce  mental  aberration,  I 
have  yet  to  see  the  case  of  insanity  due  to  the  effects  of  spinal 
concussion.  I  have  no  doubt  that  fear  and  mental  shock  inci- 
dent to  the  excitement  of  a  collision  may  give  rise  to  derange- 
ment of  the  mind  and  grave  hysteria  and  hypnotic  states  may 
be  induced. 

A  case  related  by  Page  is  that  of  a  strong  and  healthy  man 
aet.  30,  who  was  in  a  collision,  and  who  presented  the  usual 
signs  of  having  received  a  sprain  of  his  back  and  some  general 
shock  to  his  nervous  system.  He  lay  for  a  long  time  in 
a  hypnotic  state,  alternating  with  fits  of  violence  and  passion. 
When  he  awoke  from  this,  he  became  the  subject  of  a 
delusion  that  he  was  poisoned,  and  was  accordingly,  about 
ten  months  after  the  accident,  removed  to  an  asylum.  He 
remained  there  about  six  weeks  ;  and  while  an  inmate  he 
adopted  a  peculiar  gait,  which  lasted  up  to  the  time  when 
his  claim  was  settled  two  years  after  the  accident,  and 
which  formed  the  ground  of  a  very  serious  view  that  he  had 
received  a  permanent  damage  to  his  spinal  cord.  His  mode  of 
walking  was  thus  described  when  he  came  out  of  the  asylum  : 
"  He  puts  the  weight  of  his  body  on  two  sticks  placed  in  ad- 
vance of  him,  and  draws  each  leg  alternately  forward  with  the 
foot  much  everted.  When  about  to  advance  one  leg  he  twists 
the  other  inwards  on  the  toes,  so  that  the  latter  point  forwards 
instead  of  outwards.  He  keeps  the  knees  quite  stiff.  In  this 
way  he  shuffles  along  with  great  rapidity.  As  he  stood  with 
his  back  against  the  wall,  he  was  asked  to  lift  up  his  knee,  but 
he  professed  utter  inability  to  do  so."  Very  careful  examina- 
tion was  made  at  this  time  as  to  the  nutrition  and  state  of  the 
legs,  and  a  report  shortly  afterwards  by  a  very  able  physician 
runs  thus  :  "  The  reflex  irritability  and  Faradic  excitability  of 
the  muscles  of  the  lower  extremities  are  normal  ;  there  is  an 
entire  absence  of  affection  of  the  bladder  or  rectum,  or  of  any 
trophic  change  such  as  muscular  atrophy  and  bed-sores.  There 
is  also  an  entire  absence  of  muscular  tension,  rigidity,  con- 
traction, or  deformity  in  the  lower  limbs.  Examination  did 
not  enable  me  to  determine  whether  any  affection   existed  on 


37©  MEDICAL   JURISPRUDENCE. 

the  sensory  side,  as  the  patient  absolutely  refused  to  answer 
any  questions.  On  the  whole,  my  opinion  of  the  case  is  that 
it  is  an  example  of  many  recorded  instances  in  which  a  slight 
and  unimportant  injury  develops  various  emotional  and  hys- 
terical symptoms."  At  a  final  visit  made  to  him  before  his 
claim  was  settled,  he  complained  more  than  ever  of  pain  in  his 
back,  and  called  out  loudly  when  touched  upon  his  clothes. 
While  sitting  in  his  chair  he  could  move  his  legs  in  any  direc- 
tion required  of  him,  though  much  persuasion  was  necessary  to 
get  him  to  move  them  at  all.  He  suddenly  vomited  during 
our  visit,  without  any  precedent  sign  of  nausea  or  retching. 
Asked  to  walk  across  the  room  he  essayed  to  do  so  after  the 
manner  already  described.  There  was  no  tremor  of  the  legs 
during  progression,  and  nothing  like  ankle-clonus  or  the  gait 
which  is  seen  when  there  is  secondary  degeneration  of  the 
cord.  Subsequently,  on  being  asked  to  go  into  the  next  room 
he  began' to  do  so,  but  almost  immediately  fell  down  flat  on  the 
floor,  whence  he  was  lifted  and  carried  away.  A  very  large 
claim  for  compensation  was  preferred,  and  was  arranged  two 
years  after  the  accident,  not,  however,  v/ithout  a  resort  to  liti- 
gation. He  shortly  afterwards  left  the  house  in  which  he  had 
been  living,  and  for  some  time  it  was  not  known  where  he  was. 
Forty-two  months,  however,  after  the  accident  he  was  fortu- 
nately seen  by  one  of  the  medical  men  who  had  visited  him 
during  his  long  illness,  and  he  found  him  in  perfect  bodily 
health  and  vigor  and  father  of  another  child.  It  should  be 
stated,  as  having  an  important  bearing  on  the  case,  that  the 
man's  previous  history  was  bad.  He  was  always  very  irascible 
and  some  years  previous  to  the  accident  he  had  been  laid  up 
with  sunstroke.  There  was  also  some  doubtful  history  of  in- 
sanity in  his  family." 

The  Loss  of  Memory. — The  loss  of  memory  complained 
of  by  the  litigious  sufferer  is  nearly  always  a  volitional  defect, 
and  a  case  is  related  where  the  patient  was  utterly  unable,  ac- 
cording to  her  own  story,  to  remember  any  of  the  details  of 
her  previous  life  and  not  even  her  name.  Yet  she  recounted  with 
great  minuteness  all  the  circumstances  of  the  accident  and 
sliowed  intellectual  vigor  which,  to  say  the  least,  was  suspicious. 
The  real  state,  in  ninety-nine  cases  out  of  a  hundred,  is  that 
we  so  often  find  in  hysteria  and  hypochondriasis.  Emo- 
tional depression,  manifested  by  whining  complaints,  lachrymose 
concentration  upon  the  possible  termination  of  the  suit  and  the 
frequent  repetition  of  the  story  of  the  accident,  show  the  bur- 


SPINAL   INJURIES.  37 1 

den  of  his  thoughts.  I  have  never  witnessed  really  insane 
symptoms  in  uncomplicated  spinal  shock  and  I  do  not  believe 
such  are  ever  presented  except  where  there  has  been  head  in- 
jury or  advancing  degeneration  of  the  spinal  cord. 

Haemoptysis  witli  Spinal  Concussion. — In  opposition 
to  the  case  I  have  mentioned  in  which  hemorrhage  from  the 
lungs  occurred  at  the  time  of  the  accident,  is  one  reported 
by  Page,  in  which  a  malingerer  claimed  that  a  profuse  hemop- 
tysis had  occurred  after  a  slight  collision.  A  man  of  forty  five 
received  a  slight  blow  on  the  knee  and  another  on  the  sternum, 
began  to  complain  of  nerve  symptoms  two  weeks  after  the  acci- 
dent and  took  to  his  bed  where  he  remained  for  two  months. 

His  complaints  were  very  much  out  of  proportion  to  his 
actual  suffering.  The  blood  he  raised  evidently  came  from 
very  congested  fauces.  Eleven  months  afterwards  a  settlement 
was  made  with  the  railroad  company,  and  two  years  after- 
wards it  was  ascertained  that  he  had  been  at  work  for  a  long 
time,  and  was  apparently  in  perfect  health. 

Sprains  and  tlieir  Results. — As  the  result  of  an  acci- 
dent we  may  be  furnished  with  symptoms  of  pain  which  may 
be  due  to  injury  of  parts  outside  of  the  vertebral  column  and 
arise  from  sprain  or  muscular  contusion. 

Sprains  of  the  spine  are  much  more  apt  to  follow  injuries  in 
which  the  body  is  twisted  than  where  the  force  is  directly  ap- 
plied. In  the  former  case  the  pain  will  be  diffused  and  general, 
while  of  course  local  blows  will  give  rise  to  corresponding  pain 
and  stiffness.  Occasionally  we  may  find  symptoms  which  are 
indicative  of  temporary  disturbance  of  the  functions  of  the 
spinal  cord.  A  violent  wrench  may  perhaps  stretch  the  spinal 
nerve  roots,  causing  painful  symptoms,  but  I  have  never  seen 
more  than  this,  although  Holmes  reports  a  case  in  which  there 
was  some  disturbance  of  motion.  His  case  may  be  presented 
for  the  purpose,  if  nothing  else,  of  showing  how  easy  it  is  to  be 
deceived  by  a  collection  of  symptoms  which  rapidly  disappear, 
but  which  may  perhaps  be  referred  to  grave  disease  of  the  cord 
itself.*  "  A  man,  aged  31,  while  engaged  in  amusing  his  infant 
on  the  floor,  and  stooping  on  his  hands  and  feet,  was 
springing  forward  when  he  tripped  and  rolled  over  with 
his  head  under  him.  The  weight  of  his  body  came  with 
an  impulse  on  his  neck  and  gave  him  much  pain  from 
the   twist   it   caused.      He    lay   motionless   on    his   back    for 

*A  System  of  Surgeiy,  etc.,  Vol.  i,  page  789,  American  Edition. 


372  MEDICAL   JURISPRUDENCE. 

ten  minutes.  When  he  attempted  to  move  either  his  arms 
or  legs,  he  found  himself  unable,  and  he  had  a  sense  of 
numbness  and  pricking  throughout  the  body.  His  legs  gave 
way  under  him  as  if  he  were  intoxicated,  when  trying  to  stand. 
On  being  brought  to  the  hospital  it  was  necessary  to  carry  him 
into  the  ward.  When  lying  on  the  bed  he  moved  both  upper 
and  lower  extremities,  but  in  a  feeble  and  forced  manner. 
Sensation  was  not  lost,  only  impaired  ;  he  was  able  to  tell  cor- 
rectly what  part  of  his  body  or  limbs  were  touched.  Within 
twelve  hours  both  motor  power  and  sensation  were  restored, 
and  the  paralytic  symptoms  did  not  afterwards  return.  He 
complained  of  acute  pain  in  the  neck,  which  was  aggravated  by 
the  slightest  motion  of  the  head,  and  they  therefore  kept  his 
head  perfectly  still.  He  lay  in  bed  with  his  neck  sunk  on  a 
low  soft  pillow,  propped  around  with  sandbags.  On  examining 
the  neck  the  chief  tenderness  was  at  the  site  of  the  fourth  cer- 
vical vertebra,  and  there  deeply  seated  swellings  could  be  per- 
ceived. The  treatment  consisted  principally  in  the  enforce- 
ment of  absolute  rest  for  the  neck,  with  the  application  contin- 
ually of  iodine,  a  plastic  shirt  or  support  reaching  from  the 
shoulder  to  the  back  of  the  head  having  been  prepared.  He 
was  allowed  in  a  month  to  leave  us,  and  he  could  then  perform 
the  nodding  but  not  the  rotatory  motions  of  the  neck.  When 
trying  the  latter  he  turned  his  whole  body  around.  In  nine 
weeks  the  movements  of  the  body  seemed  to  be  quite  restored, 
but  he  was  kept  in  the  hospital  for  precaution's  sake  three 
weeks  longer.  He  returned  to  his  occupation,  that  of  a  shoe- 
maker, and  called  several  times  subsequently  to  show  that  he 
was  well." 

Serious  falls  and  injuries  may  give  rise  to  sprains,  which  are 
perhaps  followed  by  swelling  or  even  by  ecchymosis,  but  very 
often  there  is  no  vertebral  or  spinal  disease  ;  and  it  does  not 
do  for  us  to  too  hastily  form  a  bad  prognosis  in  cases  of  this 
kind. 

A  veritable  lumbago  of  traumatic  origin  may  be  caused  in 
the  same  way  that  it  is  by  a  fall  upon  an  icy  pavement.  In 
some  cases  we  find  muscular  rupture  which  may  follow  the  re- 
sistance dependent  u]-)on  a  fixed  attitude  the  individual  may 
assume  when  he  sees  that  a  collision  is  inevitable.  The  separa- 
tion of  muscular  fibres  or  ligamentous  attachments  give  rise  to 
localized  obstinate  pain,  which  is  aggravated  by  pressure  or 
movements  of  a  particular  kind,  such  as  bending  over  or  twist- 
ing the  body.  I  can  recall  two  cases  where  very  great  suffering 
followed  a  separation  of  some  of  the  attachments  of  the  spinal 


SPINAL   INJURIES.  373 

muscles  from  the  vertebral  processes  ;  and  in  one  of  these 
cases  a  very  extensive  rupture  followed  an  accident  which 
resulted  from  the  front  wheels  of  an  ambulance  dropping  sud- 
denly into  a  deep  hole,  and  as  a  consequence  an  army  officer 
who  occupied  the  rear  seat  was  thrown  violently  upwards  and 
forwards,  so  that  his  head  struck  the  top.  Recovery  followed 
a  period  of  great  suffering.  In  another  case  a  woman  fell  into 
a  sewer  opening  and  the  result  was  a  considerable  rupture  of 
the  fibres  of  the  latissimus  dorsi  and  the  trapezius,  resulting 
in  impairment  of  the  movements  of  the  arms  and  head.  She 
was  unable  to  use  her  arm  and  could  not  attend  to  her  house- 
hold duties  ;  she  received  handsome  compensation  from  the 
city.  In  such  cases  as  these  large  verdicts  should  not  be  ex- 
pected, for  beyond  the  immediate  pain  and  possible  swelling 
and  discoloration  and  subsequent  temporary  incapacity,  there 
is  very  little  chance  of  permanent  after-effects,  and  juries 
should  not  be  prejudiced  by  the  complaints  of  the  patient, 
which  may  become  tinged  with  hypochondriasis. 

The  Fear  of  Moving. — Page  refers  to  \hQ  fear  of  moving 
which  may  result  from  a  constant  dwelling  upon  a  slight 
painful  disturbance.  "Ask  any  man,"  says  he,  "who  has 
had  a  severe  lumbago,  whether  from  a  sprain,  from  rheu- 
matism, or  from  cold,  if  he  has  not  at  the  same  time  felt  a 
strange  sense  of  difficulty  in  moving  his  legs.  Brisk  walking 
becomes  impossible  ;  the  effort  to  put  one  leg  before  the  other 
must  be  unnaturally  great  ;  fatigue  comes  on  early  and  the 
patient  complains  to  you  that  his  legs  feel  weak  and  as  if  he 
could  hardly  move  them.  Free  micturition  may  likewise  be 
interfered  with  from  lack  of  the  natural  support  and  help  which 
the  lumbar  muscles  provide  when  this  act  is  being  performed. 
Constipation  arises  from  the  same  cause.  Thus  it  becomes 
nothing  more  nor  less  than  natural  for  the  friends  to  say  that  the 
patient  is  paralyzed,  and  paralyzed  from  severe  injury  to  the 
spine.  If  we  do  not  avoid  this  fallacy  and  do  not  correctly 
interpret  this  state  of  things,  we  shall  add  greatly  to  the  dread 
which,  after  railway  collisions,  may  be  very  real,  that  '  paraly- 
sis is  going  to  supervene.*  " 

He  relates  this  case :  "  A  man  who  had  received  such 
injuries  as  we  have  described,  and  was  confined  to  bed  in  con- 
sequence, needed  thr(;e  persons  to  help  him  out  of  bed  every 
time  he  wanted  to  pass  water  during  the  day.  To  himself  it 
appeared  wholly  unaccountable  and  extraordinary  that  when- 
ever he  woke  in  the  night  he  could  jump  naturally  out  of  bed 


374  MEDICAL    JURISPRUDENCE. 

without  any  help  for  the  same  purpose.     It  need  hardly  be  said 
that  the  case  was  perfectly  genuine." 

Pain  and  its  Character. — Great  care  should  be  taken 
not  to  confuse  the  vague  symptoms,  among  which  is  a  spinal 
pain  that  may  arise  from  lithsemia  ;  and  it  is  quite  probable  in 
some  subjects  that  anxiety,  voluntary  inaction  and  perhaps  a 
tendency  to  the  gouty  vice  may  account  for  many  of  the  symp- 
toms alleged  to  be  due  to  the  injury.  We  are  to  carefully  note 
the  relation  of  the  pain,  whether  it  be  increased  by  movements 
or  by  the  assumption  of  the  erect  position  ;  whether  it  be  asso- 
ciated with  sciatica,  whether  paresthesia,  or  if  it  is  aggravated 
by  changes  in  temperature.  We  should  always  bear  in  mind 
that  a  severe  injury  of  the  spinal  column  and  its  contents  is  by 
no  means  easily  produced  because  of  the  provisions  made  by 
nature  for  the  protection  of  this  part  of  the  body.  Not  only, 
as  it  has  been  seen,  is  the  spinal  cord  surrounded  by  fluids  and 
tough  membranes,  but  it  is  inclosed  by  elaborately  connected 
bones  separated  by  pads  of  cartilage  which  act  as  buffers, 
obviating  the  transmission  of  any  severe  shock  and  it  is  pro- 
tected behind  by  large  masses  of  muscle  and  fascia. 

Although  such  an  accident  is  improbable,  the  theory  has 
been  advanced  by  Hilton  that  when  an  individual  falls  back- 
ward, the  spinal  cord  obeying  the  law  of  gravitation,  may  be 
thrown  backwards,  dragging  the  finer  sensitive  and  motor 
nerves,  giving  rise  to  abnormal  sensations  of  a  light  grade,  and 
such  may  be  the  case  with  the  history  of  a  blow.  In  other 
cases,  as  Page  has  shown,  an  injury  of  the  sensory  nerves 
outside  of  the  spinal  canal  may  account  for  much  of  the  pain 
that  may  be  supposed  to  be  of  intra-spinal  origin. 

Pain  Rare  lu  Organic  Disease.— Gower's  observa- 
tions upon  the  connection  of  pain  with  spinal  disease  are  ex- 
ceedingly practical.  He  calls  attention  to  the  fact  that  its 
existence  in  connection  with  abdominal  and  cardiac  affections 
is  so  common  and  misleading  that  when  uncomplicated  its 
diagnostic  value  is  not  as  great  as  it  is  usually  supposed  to  be  ; 
and  it  is  no  exaggeration  to  say  that  of  a  hundred  patients  who 
complain  of  spinal  pain,  in  ninety-nine  there  is  no  disease  of 
the  spinal  cord.  This  coincides  with  my  own  observations,  and  of 
a  large  number  of  patients  that  have  come  under  my  charge 
from  time  to  time,  I  have  found  that  uncomplicated  disease  of 
the  cord  itself  was  not  attended  very  often  by  local  tenderness, 
while  in  meningitis  or  vertebral  disease  the  reverse  was  true, 


fiPTNAl.   INJURIES.  375 

Surgical  Accidents. — In  some  cases  of  spinal  injury, 
it  will  be  alleged  that  a  shortening  of  one  lower  extremity  has 
been  caused,  and  in  a  case  I  examined  recently  with  Dr.  Pea- 
body  this  was  claimed  to  be  the  fact.  It  however  transpired 
that  all  the  trouble  had  been  referred  by  the  patient  to  what 
she  was  told  was  the  unsound  limb,  although  we  did  not  find 
any  paralysis  of  either,  or  any  thing  to  account  for  the  shorten- 
ing. To  our  surprise  we  found  that  the  left  limb  was  three- 
quarters  of  an  inch  longer  than  the  right  ;  but  upon  consult- 
ing various  statistics  it  appears  that  a  large  number  of  per- 
fectly healthy  persons  present  this  congenital  defect,  so  it 
must  be  borne  in  mind  in  these  cases  that  after  all  such  dis- 
crepancies often  have  nothing  to  do  with  disease. 

Dr.  Page's  Tables. — Page  has'  tabulated  234  cases  of 
spinal  injury  received  in  railroad  accidents,  and  it  is  curious  to 
note  that  the  large  majority  of  these  are  tinged  with  a  coloring 
of  imposture,  and  it  would  appear  that  in  cases  where  the 
largest  damages -were  asked  for,  and  where  litigation  was  most 
bitter,  the  suspicion  of  malingering  was  generally  evident.  In 
many  of  these  persons  there  existed  other  diseases,  and  just  how 
much  the  symptoms  were  due  to  other  agencies  than  the  injury 
itself  it  is  difficult  to  say.  Case  II.  for  instance  suffered  from 
sciatica,  rheumatism  and  aortic  regurgitation.  This  patient, 
soon  after  the  settlement  of  the  case,  even  after  showing  some 
improvement,  was  found  dead  in  his  bed  ;  and  his  death  was 
undoubtedly  due  to  cerebral  embolism.  Several  of  the  liti- 
gants had  been  hard  drinkers  before  the  various  accidents, 
and  many  of  the  nervous  symptoms  were  undoubtedly  occa- 
sioned by  acute  alcoholism.  And  in  a  case  reported  by  Dr. 
Fletcher,  that  of  a  man  who  died  twelve  months  after  an  acci- 
dent, which  was  ascribed  to  be  the  cause  of  his  death,  it  was 
clearly  proved  that  both  before  and  after  the  alleged  injury  he 
had  several  attacks  of  delirium  tremens  In  another  individ- 
ual, the  subject  of  a  diabetes  which  ultimately  carried  him  off, 
it  was  claimed  that  the  symptoms  of  this  disease  were  entirely 
due  to  the  shock.  Page  states  that  the  diabetes  was  not  of 
that  traumatic  variety  described  by  Dr.  Buzzard. 

Bright's  Disease  and  Spinal  Injuries. — A  bad  injury 
may  be  alleged  to  be  the  cause  of  renal  disease.  When  the 
lumbar  region  is  involved  there  may  be  hematuria.  In  some 
cases,  where  spinal  injuries  have  thus  resulted,  and  where 
there  is  advancing  renal  disease,  we  must  not  be  too  ready  to 
connect  such  a  condition   directly  wich  the  tail,  lor  mere  may 


376  MEDICAL   JURISPRUDENCE. 

have  been  pre-existing  nephritis  or  other  renal  difficulties. 
Le  Gros  Clark  is  disposed  to  disbelieve  in  the  existence  of  dis- 
ease of  the  kidneys  as  a  consequence  of  injuries  to  the  spine. 
Holmes  speaks  of  a  case  in  which  a  gentleman  claimed  com- 
pensation for  injuries  which  he  declared  to  be  the  result  of  a 
railway  accident.  He  asserted  that  he  suffered  from  Bright's 
disease  of  the  kidneys,  which  was  directly  produced  by  a  blow 
upon  the  back,  and  the  injury  consisted  in  "a  bruise  over  the 
right  ilium  and  the  side  of  the  loins.  As  he  walked  some  dis- 
tance for  his  pleasure  and  took  a  long  journey  shortly  after- 
wards, it  may  be  inferred  that  the  contusion  was  not  severe. 
On  the  following  day  he  observed  blood  mixed  with  his  urine, 
and  he  continued  for  four  more  days  to  pass  blood.  On  ex- 
amining the  urine  at  that  time,  his  medical  attendants  found 
albumen  contained  in  it,  and  they  particularly  stated  that  the 
quantity  of  albumen  was  larger  in  proportion  than  could  be 
accounted  for  by  the  presence  of  the  blood.  During  the  whole 
period  from  the  date  of  the  accident  to  that  of  the  trial,  eleven 
months,  the  urine  was  found  to  contain  albumen,  and  the 
view  contended  for  by  the  witnesses  in  his  favor  was,  that  albu- 
minuria had  been  caused  by  injury  inflicted  on  the  right  kidney 
in  the  colHsion.  On  the  part  of  the  railway  company,  it  was 
asserted  that  previous  to  the  accident  the  gentleman  had  been 
subject  to  eczema,  and  that  shortly  before  it  he  had  been 
cured  under  treatment  ;  accordingly  the  medical  witnesses  on 
that  side,  the  writer  being  one,  argued  that  albuminuria  was 
known  to  follow  eczema  on  its  being  cured,  and  for  that  and 
other  reasons  which  could  not  be  stated  they  expressed  a  strong 
opinion  that  the  plaintiff  was  suffering  from  the  disease  when 
he  met  with  the  accident,  and  that  the  injury  could  not  have 
brought  it  on.  The  jury  nevertheless  awarded  heavy  damages 
for  the  sufferer." 


In  conclusion  I  may  again  refer  to  the  behavior  of  many 
of  the  patients  who  bring  suits  for  imaginary  injuries,  and  I 
cannot  use  more  forcible  words  than  those  of  Page  : 

"  With  glib  facility  of  tongue  he  talks  of  the  frauds  which 
are  so  notorious  upon  railway  companies,  but  his  own  char- 
acter is,  and  always  has  been,  above  suspicion.  His  com- 
plaints are  many  and  grievous,  but  yet  he  would  not  make 
them  worse  than  they  are,  bad  enough  though  they  be  to  keep 
him  from  his  work,  which  his  doctors  urge  him  to  resume. 
Occupation  is  impossible  ;  he  cannot  leave  the  house  ;  and  his 


SPINAL   INJURIES.  377 

religious  sense  is  shocked  that  for  so  long  he  has  not  been  to 
church.  He  can  bear  no  noise.  He  cannot  read,  and  his  only- 
diversion  is  to  hear  his  Bible  read  to  him  by  his  children  or 
his  wife.  He  is  pleased  to  see  you,  for  he  knows  how  deep 
and  true  an  interest  you  take  in  his  wretched  state  ;  and  he  is 
ever  ready  to  fall  in  with — but  not  to  adopt — the  suggestions 
you  may  make  for  his  comfort  and  the  improvement  of  his 
health.  Once  more,  as  you  leave  him,  he  assures  you  with 
Pharisaic  unction,  that  he  is  not  as  other  men,  and  that  he 
would  be  the  last  to  try  and  make  money  out  of  the  affliction 
with  which  he  has  been  visited.  His  speech  always  betrays 
him,  and  exposes  the  pious  fraud." 

Fraudulent  Pension  Claims. — Pension  boards  are  some- 
times petitioned  by  individuals  who  claim  disability  arising 
from  disease  or  injury  of  the  nervous  system  due  to  accident 
or  exposure  in  the  line  of  duty.  I  have  lately  heard  of  a  man 
who  during  the  War  of  the  Rebellion  was  struck  upon  the 
buttocks  by  a  piece  of  shell,  but  his  immediate  injuries  were 
slight.  A  few  years  ago,  after  a  period  of  good  health,  he  de- 
veloped spinal  symptoms,  indicative  of  myelitis  and  became 
paraplegic.  The  claim  of  the  man  and  his  physicians  was  that 
the  injury  was  the  direct  cause  of  the  present  disease,  which  it 
is  claimed  is  primarily  vertebral.  I  am  told  that  the  recent 
symptoms  were  sudden  in  their  onset  and  symptomatic  of 
disease  of  a  part  of  the  cord  that  could  not  possibly  have  been 
injured  in  the  accident. 

All  manner  of  bogus  attacks  of  paraplegia  are  alleged  to 
result  from  spinal  injuries  by  veritable  "old  soldiers,"  but 
often  it  is  possible  to  find  the  history  of  alcoholism,  syphilis, 
or  subsequent  exposure,  or  the  symptoms  will  not  bear  close 
examination,  and  come  under  the  class  of  cases  so  often 
claimed  to  be  the  result  of  "  spinal  concussion." 


378 


MEDICAL    JURISPRUDENCE. 


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SPINAL    INJURIES. 


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APPENDICES. 


APPENDIX  A. 

The  labors  of  the  Germans  have  materially  altered  the 
nomenclature  of  insanity  during  the  past  few  years,  and  several 
American  physicians  have  adopted  with  modifications  the  clas- 
sification of  Krafft-Ebing,  which  is  the  best. 

"  A.    MENTAL    DISEASES  OF    THE    NORMAL  BRAIN — I.    PsycJlO- 

neuroses:  i.  Primary,  curable  diseases;  a.  Melancholia — a. 
simple  Melancholia  ;  B  Melancholia  with  stupor  ;  b  Mania — 
a.  Maniacal  exaltation.  §  acute  mania;  c  Stupidity  (primary 
dementia)  or  curable  dementia;  d,  confusional  insariity. 
(Wahnsinn).  2.  Secondary,  incurable  diseases ;  a  Chronic  de- 
lusional insanity  ;  b.  terminal  demei  tia — a  with  agitation;  B. 
with  apathy. 

II.  Conditions  of  Mental  Degeneration,  a.  Constitu- 
tional affective  insanity  {ioXxo.  raisonnante,  reasoning  insanity);  b, 
moral  insanity;  c,  primary  monomania, — a  with  delusions  of 
persecution;  B.  with  delusions  of  ambition;  d  with  imperative 
conceptions;  c,  insanity  from  Constitutional  neuroses — a  epilep- 
tic; B,  hysterical:  x,  hypochondriacal;  i. periodic  insanity  [ioMQ 
circulaire.) 

III.  Diseases  of  the  Brain  with  Mental  Disturbances 
Predominating — a  Paralytic  dementia;  b,  cerebral-syphilis; 
c,  chronic  alcoholism ;  d,  senile  dementia;  e,  acute  deliriuin. 

B.  Conditions  of  Arrested  Mental  Development.  Idiocy  and 
Cretinism — "  (Folsom). 

APPENDIX  B. 

Primary  Delusional  Insanity:  A  term  applied  some- 
times to  the  variety  of  insanity  called  by  many  authors 
monomania.  According  to  Folsom  and  others  who  use 
this  name  there  are  three  forms,  i.  That  characterized  chiefly 
by  delusions  of  persecution  and  suspicion.  2.  That  by  delu- 
sions of  self-importance  (the  delire  de  grandeur  and  megalo- 
manie  of  the  French — a  form  which  has  been  called  Para- 
noia— probably  belong  to  this  class),  of  personal  power,  etc. 
3.  A  form  in  which  morbid  sensory  impressions  are  trans- 
ferred into  delusions. — As  a  rule  primary  delusional  insanity 

381 


38«  MEDICAL   JURISPRUDENCE. 

is  incurable,  though  it  may  be  attended  by  periods  of  evident 
improvement  or  almost  perfect  recovery.  The  end  is  often 
dementia.  Hallucinations  are  sometimes  presented  especially 
in  the  third  form  to  which  the  term  sensorielle  verriXcktheii  has 
been  applied. 

Primary  Confusional  Insanity  is  a  form  of  mental  disorder 
of  rather  unexpected  and  sudden  development  attended  by 
fever,  delirium  which  is  very  incoherent  and  confused  (from 
wlience  the  name) — unsystematized  delusions  and  a  phase  of 
mental  disturbance  which  somewhat  resembles  that  of  typhoid 
fever  or  toxaemia — The  prognosis  is  usually  good,  and  recovery 
is  rapid  though  there  are  many  incurable  cases. 

APPENDIX  C. 
Katatonia  is  a  term  applied  to  a  variety  of  insanity  of  a  cir- 
cular form  manifested  by  melancholia  and  by  a  disposition  to 
catileptiform  rigidity  which  may  amount  to  a  well  marked  gen- 
eral convulsion.  This  condition  should  be  differentiated  from 
the  rigidity  which  is  often  present  in  simple  melancholia. 
There  may  be  a  condition  of  erethism  which  is  expressed  in 
religious  ecstacy  or  the  various  exalted  states  described  by 
Charcot.  Hallucinations,  and  delusions  of  personal  importance, 
and  great  loquacity  of  an  inconsequential  kind  are  not  rare, 
while  delusions  of  poisoning  are  frequently  presented. 

APPENDIX  D. 
It  is  somewhat  comforting  to  those  who  stoutly  maintained 
that  Guiteau  was  responsible,  to  find  Blanford  and  other  expe- 
rienced and  careful  observers  who  have  had  ample  opportunity 
to  examine  all  the  evidence,  inclining  to  their  view  of  the  case, 
and  this  despite  the  dubious  findings  of  the  "commission" 
who  claimed  to  have  discovered  autopsical  results  when  such 
were  in  fact  really  due  to  accidental  causes. 

APPENDIX  E. 

"  Systematized  delusions  " — are  three  in  which  the  premises 
are  false  but  the  insane  belief  in  the  result  of  logical  reasoning. 

"  Unsystematized"  delusions  are  those  in  which  the  deranged 
mental  processes  cannot  be  analyzed — the  erroneous  belief 
being  an  intuitive  conviction — which  is  impossible  of  expla- 
nation. 

APPENDIX  F. 

The  condition  of  the  mind  in  the  dying  state  is  one  that  is  likely 
to  arise  in  determining  the  integrity  of  the  disposing  powers  of 


APPENDiJC.  383 

the  individual.  It  cannot  be  denied  that  the  last  hours  of  life 
are  frequently  attended  by  mental  obscuration  or  perversion 
even  when  such  does  not  appear  to  be  the  case  to  outsiders, 
and  a  person  with  some  assistance  may  be  helped  to  sign  and 
apparently  understand  a  will.  Some  diseases  when  the 
cause  of  death  is  toxaemia  or  great  exhaustion  must  some- 
times interfere  with  the  clear  exercise  of  judgment.  An  aged 
man  whose  will  was  lately  the  subject  of  contest  died  after  a 
week's  illness  the  nature  of  which  was  strangulated  hernia  and 
peritonitis — six  hours  before  death  he  was  made  to  sign  a  will 
notwithstanding  the  fact  that  a  short  time  after  he  was  so  delir- 
ious that  it  required  the  efforts  of  several  men  to  hold  him 
down,  and  he  presented  the  sign  of  collapse,  yet  he  was  pro- 
nounced by  the  consulting  physician  in  his  case  to  be  of  sound 
mind. 

APPENDIX  G. 

The  validity  of  the  will  of  a  suicide  is  sometimes  questioned. 
The  last  hours  of  most  suicides  are  as  a  rule  marked  by  some 
expression  which  will  enable  one  to  determine  the  probable 
mental  state;  de  Boismont,  Winslow  and  others  have  collected 
an  immense  number  of  letters  and  written  expressions  of  sui- 
cides, and  the  former  has  gotten  together  over  three  hundred 
and  twenty  letters  which  show  the  most  diverse  form  of  mental 
torture.  Eighty-five  wills  were  collected  by  this  observer  the 
greater  number  showing  clear  and  intelligent  disposing  power 
and  it  does  not  follow  that  because  a  suicide  has  probably 
shown  peculiarities  of  conduct  before  his  death  he  has  lost  the 
power  to  discriminate  in  the  matter  of  choosing  the  objects  of 
his  bounty.  On  the  other  hand  there  are  many  wills  made  by 
suicides  which  are  irrational  and  absurd — some  of  which  contain 
clearly  insane  directions  in  regard  to  the  disposal  of  the  body, 
the  personal  effects,  etc.  These  should  always  be  received 
with  great  caution. 

APPENDIX  H. 

The  plea  of  hysteria  as  a  reason  for  divorce  has  never  so  far 
as  I  know  been  advanced  in  this  country  though  in  France  its 
true  importance  has  long  been  recognized.  Doubtless  many 
cases  of  incompatibility,  have  been  dismissed  as  unworthy  of 
judicial  interference  when  the  res  grsta  was  mental  trouble,  of 
a  light  grade,  and  not  mere  bad  temper.  Many  hysterical 
women  are  the  subject  of  one  or  other  of  the  light  primary 
forms  of  congenital  deficiency  which  brings  with  it  more  or 
less  irresponsibility.      A  history  of  repeated   and  motiveless 


384  MEDICAL  JURISPRUDENCE. 

irregularities  of  conduct,  domestic  infelicity  intensified  usually 
about  the  time  of  menstruation  is  suggestive  of  original  brain 
disease.  Sometimes  hysterical  women  will  bring  divorce  suits 
for  imaginary  wrongs — other  than  those  I  have  detailed.  A 
case  of  this  kind  came  up  in  the  French  Courts  the  plaintiff 
being  a  woman  named  Vincent  v/^ho  had  been  placed  by  her 
husband  in  an  asylum  when  she  was  suffering  from  an  attack 
of  hysterical  insanity.  After  her  discharge  she  brought  suit 
for  divorce  alleging  that  his  part  in  the  commitment  was  a 
sufficient  wrong  which  was  denied  by  the  tribunal. 

Recourse  to  the  Courts  may  be  necessary  in  matters  where 
the  existence  of  hysterical  or  epileptic  convulsions  preceded  the 
marriage  and  where  the  husband  took  to  himself  a  wife  when 
he  was  ignorant  of  any  existing  disease.  Du  Sauld  calls  atten- 
tion to  the  fact  that  Doctors  are  frequently  consulted  by  parents 
as  to  whether  marriage  is  likely  to  put  an  end  to  epileptic  or 
hysterical  attacks,  and  they  frequently  meet  with  the  assurance 
that  such  will  be  the  case.  There  can  be  no  doubt  as  to  the 
falsity  of  any  such  conclusion  in  many  cases,  and  concealment 
even  with  the  best  motives  in  the  world  is  in  every  way  an  act 
of  injustice. 

APPENDIX  I. 

The  existence  of  ample  motive,  deliberation  and  the  taking  of 
precautions  that  would  ensure  a  painless  death  were  shown  in  a 
case  in  which  I  was  called  shortly  after  the  appearance  of  the  first 
edition  of  this  book.  The  suicide  A,  was  a  Jewish  merchant  who 
had  become  involved  in  heavy  business  reverses  and  became  the 
debtor  of  B.,  a  more  prosperous  and  exacting  fellow-trader  of 
his  own  race  who  like  his  prototype  in  the  Merchant  of  Venice 
was  persistent  in  his  demands  to  such  a  degree  that  a  policy  of 
Insurance  was  obtained  in  the  Mutual  Life  Insurance  Co.  of 
this  city.  The  affairs  of  the  insured  man  grew  worse  and  worse, 
and  certain  penalties  for  alleged  irregularities  of  criminal  nature 
were  hinted  at  by  the  impatient  creditor  and  tlie  result  was  the 
suicide  of  the  unfortunate  man  who  first  ])rovided  himself  with 
a  heavy  block  of  lead  and  copper  wire  with  which  he  fastened 
the  former  inside  of  his  pocket  and  then  leaped  from  the  deck 
of  a  ferry-boat  into  the  river.  He  had  some  time  before  his 
death  assigned  his  policy  to  B.  who  sued  the  Company  alleging 
that  A.  had  committed  suicide  whilst  insane.  The  only  evi- 
dence brought  forward  was  the  antecedent  mental  depression 
of  A.  which  was  very  natural  under  the  circumstances. 


INDEX. 


Abscesses,  Brain 321 

Aphasia,    Medico-Legal     Rela- 
tions of , lOI 

Aphasia  with  Responsibility...  102 
Alcoholic  Epileptics,    Impulses 

in  the 251 

Trance 252 

Alcoholism 248 

and  Civil  Actions 264 

and  General  Paresis,  Diag- 
nosis between 257 

and  Life  Insurance.. 274 

and  Responsibility 258 

Character  Changes  in  ....  255 

Development  of 248 

Divisions  of 248 

Epileptiform  Attacks  in. . .  251 

Fixed  Ideas  in 256 

Hallucinations   of 249 

Heredity   in 255 

in  Cranial   Injuries 321 

Loss  of  Memory  in 252 

Mental  State  in 249 

Testamentary  Capacity  in.  271 
Arrest  of  Heart's  Action,  Volun 

tary 204 

Assaults,  Pretended 187 

Pretended,  by  Dentists... .  190 

Barr  Case,  The 157 

Brain  Abscesses 321 

Compression  of  the 317 

Breach  of  Promise  and  Insanity.  117 
Bright's  Disease  and  Spinal   In- 
juries   375 

Capacity,  Testamentary 79 

Cerebral  Irritation 309 

Cerebri,  Contusio 318 

Cerebri,  Herniae 335 

Character  Changes  in  Alcohol- 
ism   255 

Children,     Hysteria     in     -Very 

Young 173 


385 


Chloroform  and  Hysteria 189 

and  Robbery 193 

Circular  Insanity. 42 

Classification  of  Erb, 353 

Clegg  The  Impostor,  Case  of. ..   240 
Clymer  upon  the  Responsibility 

of  Epileptics 224 

Commissio  de  Lunatico  Inquir- 

endo 145 

Commitment   of   Drunkards...   264 

of  Lunatics 143 

Concealed  Insanity 151 

Concussion  and   Compression. .   304 

and  Meningitis 309 

of  the  Brain 309  317 

Spinal 352 

Fatal  Cases  of 355 

Trophic  Changes  in 354 

Congenital  Viciousness 29 

Contracts,  Business 112 

made  by  the  Insane 78 

Contractures,    Hysterical 178 

Simulated 213 

Contrecoup 323    306 

Contusio  Cerebri 318 

Convulsions         in        Paralyzed 

Limbs 318 

Cortical  Epilepsy 221 

Counsel,  Tricks  of 71 

Cranial  Injuries 301 

Anatomical  Considerations 

in 301 

Affections  of  Intellect  and.   310 
Condition  of  Duality  and. .   310 

Deafness  and 318 

Erysipelas  and 322 

Meningitis  and 312 

Sexual  Perversion  in 309 

Complicated     with      other 

Diseases 320 

Kind  and  Direction  of  Vio- 
lence in 305 


3S6 


INDEX. 


Cranial  Injuries,  in  Alcoholism  321 

in  Children 319 

Latent  Disease  in 319 

Otitis  in 321 

Symptoms  of 303 

Trivial 323 

and  Epilepsy,  Case  of 313 

and  Memory 314 

and  Previous  Disease 329 

and   Pyemia 328 

and  Speech. . . , 330 

Extravasation  in 329 

from  Blows  w^ith  the  Fist...  325 

Infanticide  by 341 

Prognosis  of 326 

without  External  Lesion...  323 

Cranial  Nerves,  Injury  of 308 

Cranial  Wound,  Character  of. .  339 

Cretinism 23 

Crimes,  Abominable 184 

Crimes,     Undue    Influence     in 

Relation  to loo 

Criminal  Acts,  Relations  of  to 

Sleep 48 

Criminal  Responsibility  of   the 

Deaf  and   Dumb 129 

Cutaneous  Conditions,  Feigned  214 
Damages,    Civil    Suits    for,    in 

Cranial  Injuries 340 

Deaf  and  Dumb,  the  Responsi- 
bility of , 126 

Deafness  and  Cranial  Injuries. .  318 

Feigned 215 

Delirium  as  distinguished  from 

Mania 42 

Delirium  Tremens  and  Respon- 
sibility    256 

Delusions 75 

Concealed 76 

not  necessarily  Expressed  in 

Conversation 76 

of  Grandeur 45 

Dementia 25 

and  Old  Age 79 

Complete 27 

Feigned 157 

Partial 27 

Secondary 26 

Senile 27 

Desire  for  Notoriety 182 

Destructive  Tendencies,  Hyste- 
ria with 182 

Diagnosis    Hasty,    Danger   of.  203 

Dipsomania 33 


Disease  Apparently  Feigned.. .  203 

Diseases  Feigned 199 

of  the  Womb,  Feigned. ...  214 

Dislocation  of  Vertebrae 346 

Disposing  Mind,  The  Test  of  a.     80 

Divorce  and  Epilepsy 235 

and  Insanity 118 

Duties  of  the  Medical  Expert. .  71 
Drunkards',  Commitment  of.  ,  264 

Habitual ., 264 

Insane 250 

Responsibility  of 256 

Drunkenness  and  Suicide 284 

Duality,  Condition  of,  and  Cra- 
nial Injuries 310 

Due  de  Bourbon,  The  Case  of..  285 
Eccentricity     in     Relation     to 
Testamentary   Capacity....       go 

Embranlement 360 

Epidemic  Hysteria l8l 

Epilepsy 221 

and  Crania]  Injury,  Case  of  313 

and  Divorce 235 

and  Hallucinations 233 

and  Marriage 234 

and  Somnambulism 49 

and  Testamentary  Capacity  227 
and  the  Sphygmograph. . . .   240 

Cortical ' 221 

Feigned • 238 

Head  Injury  in 222 

Hughlings  Jackson  on. . . .  226 

Lighter  Grades  of 227 

Medico-Legal  Applications 

in  Relation  to 229 

Memory  in  Relation  to.*..   233 

Mental  Condition  of 223 

Nocturnal 232 

Reflex 222 

Traumatic 221 

Epileptic  Insane,  Crimes  of. . .  236 
Epileptic,  Realization  of  Crime 

by  the 231 

Epileptics,    Character   of   Con- 
genital   225 

Clymer    on    Responsibility 

of 224 

Responsibility  of 229 

Epileptiform    Attacks   in  Alco- 
holism  251 

Erb's  Classification 353 

l'  rysipelas'and  Cranial  Injury. .  322 
Examination  of  the  Patient....  69 
Extravasation     in     the     Mem- 


387 


branes  of  the  Cord 350 

Expert.  Duties  of    the  Medical.     71 

Eye  Diseases,  Feigned 215 

Feigned   Cases  of  Spinal  Con- 
cussion    365 

Deafness 215 

Dementia 157 

Diseases igg 

Diseases  of  the  Uterus. . . .   214 

Eye  Diseases 215 

Epilepsy 238 

Hemorrhagic      and     Cuta- 
neous Diseases 214 

Hemiplegia 210 

Idiocy 156 

Imbecility 156 

Insanity 152 

Insanity,     Doubtful    Cases 

of 169 

Locomotor  Ataxia 209 

Mania 155 

Melancholia 156 

Pain 199 

Paralysis  209 

Somnambulism 208 

Spasmodic  Diseases 204 

Unconsciousness 204 

Unconsciousness,  Tests  for  207 

Fixed  Ideas  in  Alcoholism 256 

Folic  Circulaire 42 

Fractures  of  the  Skull 306 

Fracture  of  the  Spine  without 

Displacement 346 

Genius  and  Insanity 69 

Guiteau  Case,  The 62 

General  Paresis  and  Alcoholism, 

Diagnosis  between 257 

Paresis  of  the  Insane  ....     44 
Hemoptysis   with    Spinal  Con- 
cussion  371 

Hemorrhagic      and    Cutaneous 

Conditions  Feigned 214 

Hallucination  and  Suicide 290 

Homicide  as  the  Result  of.     36 

Hallucinations 73 

and  Epilepsy 233 

Disorderly     Conduct      Ex- 
plained by. . . .  • 74 

of  Alcoholism 249 

Handwriting  of  the  Insane....    112 

Head  Injury  in  Epilepsy 222 

Heart's   Action,    Voluntary  Ar- 
rest of 204 

Hemiplegia  Feigned 210 


Heredity  in  Alcoholism 255 

Hereditary  Influence 51 

Hernia   Cerebri 335 

Hip  Joint  Disease,  Simulated..   201 
Homicide    as     the     Result    of 

Hallucination 36 

Distinguished  from  Suicide  277 
Homicidal  Injury,  Accidental. .   340 

Insanity  Reasoning 40 

Mania • 35 

Mania  with  or  without  De- 
lusions      37 

Homicide  or  Suicide,  Post  Mor- 
tem Determination  of 332 

through  Insane  Inspiration.  41 
Hutchinson  upon  Malingerers. .  202 
Hypochondriasis  and  SpinalCon- 

cussion 365 

Hysteria  and  Chloroform 189 

and  Lust 170 

and  Pretended  Suicide. . . .    184 
and  Spinal  Concussion. . . .  367 

Epidemic 181 

in  its  Relation  to  Organic 

Disease 197 

in  Men 196 

in  Very  Young  Children. . .   173 
Manifested     in     Religious 

Vagaries 171 

Medico-Legal      Considera- 
tion of 170 

Nature  of 170 

with   Destructive   Tenden- 
cies    182 

Hysterical  Patients,  Self-Mulila- 

tionby 185 

Simulation  of  Real  Diseases  176 
Subject,     Responsibility  of 

the T98 

Traumatic  Contractures. . .    178 

Idiocy 21 

Feigned 156 

Idiots,  Head  Configuration  of ..     22 

Idiot,  Legal  Status  of  the 126 

Illusions 72 

Imbecility 24 

Feigned 156 

Responsibility  in    Relation 

to • 130 

Impeachment  by  Reason  of  In- 
sanity    116 

Impulses  in  the  Alcoholic  Epi- 
leptic    251 

Impulsive  Insanity. . , 136 


388 


INDEX. 


Infanticide  by  Cranial  Injury  . .  341 

Influence,   Undue 96 

Injuries,  Cranial 3or 

Cranial,  in  Children 319 

Cranial  Symptoms  of 303 

of  Cranial  Nerves 308 

Homicidal,  Accidental. .. .  340 

Skull,  Prognosis  of 334 

Insane,  Contracts  made  by  the.     78 

Cunning  of  the 38 

Drunkards 250 

General  Paresis  of  the. ...     44 

Handwriting  of  the 112 

Inspiration,    Homicide 

through 41 

Post  Mortem  Examination 

of 52 

Punishability  of  the 198 

Puerperal,  Crimes  of  the. . .     43 
Insanity  and  Breach  of  Promise.   117 

and  Divorce 118 

and  Genius 69 

and  Life  Insurance 122 

and  Marriage 116 

and  Spinal  Concussion. . . .  369 

Circular 42 

Classification  of 18 

Concealed 151 

Definition  of 17 

Dissolution  of  Partnership 

by  Reason  of 115 

Doubtful  Cases  of  Feigned.   169 

During  Litigation 330 

Epileptic 230 

Epileptic,  Crimes  of 236 

Feigned 132 

General  Consideration  of..      17 
General  Indications  of. ...      18 

Homicidal  Reasoning 40 

Impeachment    by    Reason 

of 116 

Impulsive 136 

in  Relation  to  Theft 142 

Legal  Relations  of 61 

Moral  and  Partial 20 

Somatic  Classification  of. .     20 

The  Border  Land  of 62 

The     Popular,    versus   the 

Scientific  View  of 151 

Intellect,     Affections     of,    and 

Cranial  Injuries 310 

Intervals,   Lucid , 77 

Jackson,  Hughlings,  on  Epilepsy  226 
Kleptomania 31 


Legal  Relations  of  Insanity. ...     61 

Status  of  the  Idiot 126 

Lead  Paralysis  and  Spinal  Con- 
cussion  358 

Legal  Terms 72 

Tests 61 

Life  Insurance,  and  Alcoholism  274 

and  Insanity. . . .  • 122 

and  Suicide 291 

Locomotor  Ataxia,  Feigned. . ,   209 
as    the    Result   of    Spinal 

Concussion 357 

Lucid  Intervals 77 

Lunatics,  The  Commitment  of.   143 

Lust  and  Hysteria 170 

Malingerers,  Hutchinson  upon.  202 

Mania 30 

Acute    and    Chronic,    Dis- 
tinction between 42 

Delirium    as  distinguished 

from 4.2 

Feigned 155 

Homicidal 35 

Reasoning 76 

Suicidal. 33 

Marriage  and  Epilepsy 234 

and  Insanity I16 

Max  Klinger,  The  Case  of . . . .  245 
Medico-Legal  Consideration  of 

Hysteria • 170 

Relations  of  Aphasia loi 

Questions  of  Suicide. 375 

Melancholia 28 

Feigned 156 

Memory  and  Cranial  Injury...  314 
In  Relation  to  Epilepsy...  233 

Loss  of  in  Alcoholism 252 

Loss  of,    in  Spinal  Concus- 
sion  370 

Men,  Hysteria  in 196 

Meningitis  and  Concussion. . . .  309 

and  Cranial   Injuries 312 

Mental  Condition  of  Epileptics.  223 

State  in  Alcoholism 249 

Monomania 20 

Mutilation 2i8 

Myelitis  from  Compression....  348 

Nocturnal  Epilepsy 232 

Notoriety  Love  of,  by  Suicides.  291 

The  Desire  for.- 182 

Nymphorrrania. 35 

Ocular    Symptoms     of     Spinal 

Concussion 3^4 

Old  Age  and  Dementia 79 


INDEX. 


3S9 


Otitis  in  Cranial  Injuries 321 

Orbital  Wounds 334 

Ordronaux  on  Responsibility. . .    135 
Organic  Disease,  Hysteria  in  its 

Relation  to 197 

Page's  Table  of  Spinal  Injuries  375 

Pain  and  Spinal  Disease 374 

in  Spinal  Injuries 374 

Feigned 199 

Paresis,  General,  Disputed  Cases 

of 46 

of  the  Insane 44 

Periods  of  Remission  in..     46 

Paralysis  Feigned 2og 

Partnership,  Dissolution  of  by 

Reason  of  Insanity 115 

Physical  Tests 70 

Poisoning,  Suicide  by 289 

Post-Paroxysmal   Condition. . . .    224 
Post-Mortem    Examination    of 

the  Insane 52 

Pott's   Disease 348 

Premeditation 37 

Pretended  Assaults , . . .    187 

Assaults  by  Dentists 190 

Puerperal    Insane,     Crimes    of 

the 43 

Pulse   Changes    in  Spinal  Con- 
cussion    362 

Punishability  of  the  Insane. . . .   198 
Pyemia  and  Cranial  Injury. . . .   328 

Pyvomania 32 

Reasoning   Mania 76 

Reflex  Epilepsy 222 

Responsibility,    American    De- 
cisions in  Regard  to 133 

and  Alcoholic- 1 258 

Aphasia  wil'.a 102 

and  Deliriii;!  Tremens.. . .   256 
Criminal,  of   the  Deaf  and 

Dumb..    129 

in  Relation  to  Imbecility       130 
of  Drunkards,  Le  Grand  du 

SauUe  on. 256 

of  Suicides 299 

of  the  Deaf  and  Dumb. ...    126 
of  the  Hysterical  Subject. .    198 

Ordonaux  on 135 

The  English  Test  of, 132 

Right  and  Wrong,  The  Test  of  134 

Robbery  and  Chloroform J93 

Satyriasis 35 

Sclerosis,    Postero-Lateral    and 
Spinal  Concussion 357 


Sexual  Perversion  and  Cranial 
Injuries 309 

Sleep,  Relation  of  Criminal  Acts 
to 48 

Self  Inflicted  Wounds 217 

Self-Mutilation    by    Hysterical 
Patients 185 

Simulated   Contractures 213 

Hip  Joint  Disease 201 

Simulation  of  Disease,  Hysteri- 
cal 176 

Skull,  Fracture  of 306 

Injury,  Prognosis  of 334 

Penetrating  Wounds   of...   337 

vSpasmodic  Affections   Feigned.   204 

Spinal  Concussion 352 

and  Hysteria 367 

and   Hypochondriasis 365 

and  Insanity 369 

and  Lead  Paralysis 358 

and  Suits  for  Damage 359 

Fatal  Cases  of 355 

Feigned  Cases 365 

Hemoptysis  with 371 

Lighter  Forms  of 361 

Locomotor  Ataxia  a  result 

of '•••  357 

Loss  of  Memory  in 370 

Ocular  Symptoms  of 364 

Pulse  Changes  in 362 

Trophic  Changes  in 354 

Spinal  Cord,  Clot  in  the. . .  351 
Extravasation  in  the  Mem- 
branes of 350 

General  Anatomy  of 342 

Laceration  of 352 

Spinal  Disease  and  Pain..  374 
Fracture  Complicated  with 

Dislocation 347 

Spinal  Injuries 342 

and  Bright's  Disease....  375 

and  Pain 374 

Localization  of 343 

Page's  Tables  of 375 

Dislocation  with 346 

Forms  of 345 

Symptoms  of 346 

Sprains 371 

Spine,  Fracture  of  without  Dis- 
placement    346 

Sodomy 184 

Somnambulism  and  Epilepsy. .  49 

Feigned 208 

Subiective  Symptoms  in  Cranial 


390 


INDEX. 


Injuries 303 

Suicidal  Attempts,  Persistence  of     36 

Mania 33 

Wound,  Location  of  the. . .   278 

Seat  of 279 

Suicide 275 

and  Drunkenness 284 

and  Hallucinations 290 

and  Life  Insurance 291 

by  Drowning 280 

by  Hanging 284 

by  Men  or  Women 280 

by  Poisoning 289 

Deliberate  Preparations. . .   280 
Direction  of  the  Wound  in  276 
Distinguished  from    Homi- 
cide      277 

Doubtful  Case  of 296 

Evidences  of 283 

Multiple  Attempts 280 

Number  of  Wounds  in....  277 
or  Homicide,  Post  Mortem 

Determination  of 332 

Pretended,  and  Hysteria..  184 
Pre-existing  Disease  in. . . .  290 
and  Love  of  Notoriety. . . .  291 

Contusions  in • 279 

Modes  of  Death  in 275 

Responsibility  of 299 

Wounds  Inflicted  by. ..., .   276 

lardieu's  Formula 69 

Terms,  Legnl 72 

Testamentary  Capacity 79 


and  Epilepsy 227 

Eccentricity  in  Relation  to     90 

in  Alcoholism 271 

Test  of  a  Disposing  Mind 80 

of  Responsibility,  the  Eng- 
lish    132 

of  Right  and  Wrong I34 

of    Feigned    Unconscious- 
ness     207 

Legal 61 

Physical 70 

Theft,  Insanity  in  Relation  to.   142 

Trance 207 

Alcoholic 252 

Traumatic  Epilepsy 221 

Tricks  of  Counsel 71 

Unconsciousness,  Feigned 204 

Undue  Influence 96 

in    Relation  to  Crime. . . .   loo 

Viciousness,  Congenital 24 

Voisin    on    the    Sphygmograph 

and   Epilepsy 240 

Waltz  Case,  The  163 

Walworth  Case,  The 236 

Weak  Mindedness 24 

Whittaker  Case 205 

Wounds,      Bullet      and     their 

Results 335 

Orbital 334 

Penetrating  of  the  Skull...   337 
Possible  Method   of  Inflic- 
tion  338 

Self  Inflicted 217 


APPENDIX. 


Notes  A  to  H. page  381. 


PHOTOGRAPHIC  ILLUSTRATIONS  OF 

DISEASES. 

[Forty-eight  Quarto  Plates,  Sixty  Cases  from  Life.] 
By    GEORGE    HENRY    FOX,    A.M.,    M.D., 

Clinical  Lecturer  on  Skin  Diseases,  College  of  Physicians  and  Surgeons,  New  York? 

Surgeon  to  the  New  York  Dispensary,  Department  of  Skin  and  Venereal  Diseases; 

Fellow  of  the  American  Academy  of  Medicine  ;  Member  of  the  New  York 

Dermatologlcal  Society,  che  American  Dermatological  Association,  etc. 

The  large  experience  and  reputation  of  Dr.  Fox  in  this  department 
eminently  qualify  him  for  the  preparation  of  so  important  a  work. 
As  Surgeon  to  the  Skin  and  Venereal  Department  of  the  New  York 
Dispensary,  where  upward  of  five  thousand  cases  are  treated  annu- 
ally, he  has  had  ample  amount  of  clinical  material  from  which  to 
select  cases.  He  has  had  access  to  and  selected  from  several  thou- 
sand negatives,  taken  from  patients  in  Bellevue  and  Charity  Hos- 
pitals. He  has  also  drawn  from  other  Dispensaries  and  Hospitals 
both  in  New  York  and  Brooklyn,  through  the  kindness  of  physicians 
in  charge. 

The  COLORING  is  a  special  feature  of  the  work,  which  has  been 
entrusted  to  a  skillful  anatomical  artist,  J.  Gaertner,  M.D.,  for- 
merly a  physician  and  student  under  Hebka,  in  the  General  Hospital 
of  Vienna.  These  plates  are  carefully  colored  by  hand  and  more  ac- 
curately represent  disease  than  any  lithographs  or  colored  photo- 
graphs which  have  ever  been  offered  to  the  profession. 


CONDITIONS. — The  work  is  published  in  Twelve  Parts,  each  part  consisting;  cf 
four  plates  printed  from,  the  original  photographic  negatives,  by  a  new  and  indexible 
process,  on  fine  quality  of  heavy  card-board,  10  x  12  inches,  colored  by  hand,  giving 
in  each  case  the  characteristic  and  life-like  effects  of  the  disease.  Two  pages  of 
text  accompany  each  plate. 

This  work  will  be  sold  only  by  our  duly  authorized  Canvassing  Agents. 

No  Subscriber's  name  will  be  taken  for  less  than  the  entire  work. 

price:,  per  part,  $2. 

Complete,  Half  Boan  Binding,  $26.73;  in  Half  Tnrkey  Moroeeo,  $28. 


NOW  READY.  FHOTOGSAFHIC  ILLUSTEATIONS  OF 

Cutaneous  syphilis 

By  GEORGE  HENRY '^  FOX,  A.M.,  M-D. 

48  Plates,  Seventy  Cases  from  Life.    Terms  and  conditions  as  above. 


THE  INTERNATIONAL 

M  MEDICAL 
ANNUAL.1890. 

A  Complete  Work  of  Reference  for  Medical  Practitioners, 
Edited  I37  P.  W.  WILLIAMS,  M.D.,  Secretary  of  Staff. 

Assisted  by  a  Corps  of  Tnirty-Seveu  Distinguished  Collaborators  vride- 
ly  knovru  ia  Europe  and  America. 

First.    The  Dictionary  of  New  Remedies. 

With  this  is  incorporated  a  review  of  the  general  Therapeutics  of  the 
year  and  to  which  is  added  an  Index  of  Diseases  showing  at  a  glance 
the  new  remedies  which  have  been  recommended  in  any  given  disease, 
and  the  page  upon  which  the  prescription  will  be  found.  It  forms  a 
very  comprehensive  and  useful  survey  of  the  multitude  of  new  remedies 
that  have  been  recently  brought  under  the  notice  >f  the  medical  pro- 
fession in  Europe  and  America.  The  fact  that  it  iuciudes  the  results  of 
recent  experiments  with  many  valuable  drugs  that  have  lost  the  charm 
of  novelty  makes  the  volume  more  complete  as  a  reference  book;  ar- 
ranged in  dictionary  order  under  the  name  of  the  remedy. 

Second,  The  Dictionary  of  New  Treatment. 

Comprises  a  remarkably  full  resume  of  the  medical  literature  of 
the  year  giving  the  new  methods  of  treatment  in  Medicine  and  Surgery 
which  have  come  to  light  in  all  parts  of  the  world  and  been  recom- 
mended since  jhe  publication  of  the  Dictionary  of  New  Treatment  of 
1889  ;  with  original  articles,  suggestions,  and  observations  by  specialists 
anl  the  editors  in  charge  of  the  several  departments.  A  veritable  ?n«Z- 
tum  inparvo  of  information  of  great  value  for  the  dispensim;  chemist 
as  well  as  the  medical  practitioner.  Alphabetically  arranged  under  the 
name  of  the  disease;  each  article  bearing  the  name  of  the  contributor. 

8th  Annuallasue.]  [Uniform  with  "Medical  Classics  Series." 

In  one  large  octavo  Volume.     Illustrated.     Over  600  pages.  $2,75. 

E.  B.  TREAT,  Publisher,  5  Cooper  Union,  New  York. 

Medical  Students  and  Agents  Wanted. 


COLUMBIA  UNIVERSITY 

This   book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE   BORROWED 

DATE  DUE 

c2e<e3aiMeo 

RA1151 

H18 

/ 

Kami It on 

1887 

# 

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